title: The use of back-up units to enhance the safety of unrelated donor cord blood transplantation.
abstract: The inability to obtain additional stem cells is a disadvantage of unrelated donor cord blood transplantation (CBT). Moreover, in the event of problems with unit shipment, compromised unit quality, thaw mishaps, or graft failure, the time to secure a back-up graft could be unacceptable. Emergent shipment of 1 to 2 back-up units that have been previously typed and reserved could overcome this limitation. However, the advantages of this approach are not established. Therefore, we present our use of back-up units over a 5.5-year period. Six of 121 CBT recipients (5%) required back-up unit infusion. Indications included shipment mishaps (n = 2), poor unit viability (n = 2), significant infusion reaction (n = 1), and graft failure (n = 1). Lack of back-up units would have caused transplantation delay or infusion of inferior-quality units. Five of the 6 patients achieved sustained donor engraftment. We demonstrate that back-up units are emergently required in a significant minority of patients, supporting the incorporation of at least 1 back-up unit in cord blood (CB) selection algorithms to enhance CBT safety.
authors.affiliation: Adult Bone Marrow Transplantation, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
authors.forename: Doris M
authors.initials: DM
authors.lastname: Ponce
authors.forename: Marissa
authors.initials: M
authors.lastname: Lubin
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Gonzales
authors.forename: Courtney
authors.initials: C
authors.lastname: Byam
authors.forename: Deborah
authors.initials: D
authors.lastname: Wells
authors.forename: Rosanna
authors.initials: R
authors.lastname: Ferrante
authors.forename: Glenn
authors.initials: G
authors.lastname: Heller
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
authors.forename: Esperanza B
authors.initials: EB
authors.lastname: Papadopoulos
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Kernan
authors.forename: Andromachi
authors.initials: A
authors.lastname: Scaradavou
authors.forename: Juliet N
authors.initials: JN
authors.lastname: Barker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000628:therapy*; D006086:Graft vs Host Disease / Q000276:immunology / Q000517:prevention & control*; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D008232:Lymphoproliferative Disorders / Q000276:immunology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013048:Specimen Handling; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D019737:Transplants / Q000600:supply & distribution*; D061349:Unrelated Donors