title: Immune reconstitution after cord blood transplantation: peculiarities, clinical implications and management strategies.
abstract: Umbilical cord blood (UCB) is now widely used as an alternative hematopoietic stem cell source for patients lacking closely matched related or unrelated adult donors. UCB transplantation has traditionally been associated with delayed engraftment, poor immune reconstitution and consequent increased risk of infection. More recent clinical studies, however, suggest that conditioning regimens and in particular the omission of in vivo T-cell depletion may play a crucial role in post-transplant T-cell expansion, facilitating a uniquely rapid immune recovery after UCB transplantation. The peculiar characteristics of UCB cells, the importance of thymic function and the role of conditioning regimens and graft-versus-host disease influencing immune reconstitution are described. The last part of the review reports available data on UCB, as well as third-party peripheral blood derived anti-viral cell therapy, which provides a novel approach to rescue UCB recipients with viral complications in the post-transplant period.
authors.affiliation: Bone Marrow Transplantation Department, Great Ormond Street Hospital, London, United Kingdom. Electronic address: Giovanna.Lucchini@gosh.nhs.uk.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Lucchini
authors.affiliation: Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, USA.
authors.forename: Miguel-Angel
authors.initials: MA
authors.lastname: Perales
authors.affiliation: Bone Marrow Transplantation Department, Great Ormond Street Hospital, London, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Veys
mesh_terms: D036101:Cord Blood Stem Cell Transplantation; D016207:Cytokines / Q000378:metabolism; D005312:Fetal Blood / Q000166:cytology / Q000276:immunology* / Q000637:transplantation; D006801:Humans; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology
chemical_list: D016207:Cytokines
keywords: T cells; immune-reconstitution; serotherapy; stem cell transplantation; thymic function; umbilical cord blood; viral infections