title: Optimal Practices in Unrelated Donor Cord Blood Transplantation for Hematologic Malignancies.
abstract: Unrelated donor cord blood transplantation (CBT) results in disease-free survival comparable to that of unrelated adult donor transplantation in patients with hematologic malignancies. Extension of allograft access to racial and ethnic minorities, rapid graft availability, flexibility of transplantation date, and low risks of disabling chronic graft-versus-host disease (GVHD) and relapse are significant advantages of CBT, and multiple series have reported a low risk of late transplantation-related mortality (TRM) post-transplantation. Nonetheless, early post-transplantation morbidity and TRM and the requirement for intensive early post-transplantation management have slowed the adoption of CBT. Targeted care strategies in CBT recipients can mitigate early transplantation complications and reduce transplantation costs. Herein we provide a practical "how to" guide to CBT for hematologic malignancies on behalf of the National Marrow Donor Program and the American Society of Blood and Marrow Transplantation's Cord Blood Special Interest Group. It shares the best practices of 6 experienced US transplantation centers with a special interest in the use of cord blood as a hematopoietic stem cell source. We address donor search and unit selection, unit thaw and infusion, conditioning regimens, immune suppression, management of GVHD, opportunistic infections, and other factors in supportive care appropriate for CBT. Meticulous attention to such details has improved CBT outcomes and will facilitate the success of CBT as a platform for future graft manipulations.
authors.affiliation: Department of Medicine, Memorial Sloan Kettering Cancer Center New York, New York. Electronic address: barkerj@mskcc.org.
authors.forename: Juliet N
authors.initials: JN
authors.lastname: Barker
authors.affiliation: Departments of Pediatrics and Medicine, Duke University, Durham, North Carolina.
authors.forename: Joanne
authors.initials: J
authors.lastname: Kurtzberg
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Karen
authors.initials: K
authors.lastname: Ballen
authors.affiliation: National Marrow Donor Program (NMDP), Minneapolis, Minnesota.
authors.forename: Michael
authors.initials: M
authors.lastname: Boo
authors.affiliation: Departments of Medicine and Pediatrics, University of Minnesota (U of MN), Minneapolis, Minnesota.
authors.forename: Claudio
authors.initials: C
authors.lastname: Brunstein
authors.affiliation: Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Corey
authors.initials: C
authors.lastname: Cutler
authors.affiliation: Departments of Pediatrics and Medicine, Duke University, Durham, North Carolina.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Horwitz
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Filippo
authors.initials: F
authors.lastname: Milano
authors.affiliation: Department of Medicine, M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Amanda
authors.initials: A
authors.lastname: Olson
authors.affiliation: National Marrow Donor Program (NMDP), Minneapolis, Minnesota.
authors.forename: Stephen
authors.initials: S
authors.lastname: Spellman
authors.affiliation: Departments of Medicine and Pediatrics, University of Minnesota (U of MN), Minneapolis, Minnesota.
authors.forename: John E
authors.initials: JE
authors.lastname: Wagner
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Colleen
authors.initials: C
authors.lastname: Delaney
authors.affiliation: Department of Medicine, M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shpall
mesh_terms: D036101:Cord Blood Stem Cell Transplantation / Q000379:methods* / Q000401:mortality / Q000592:standards; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy*; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards; D061349:Unrelated Donors
keywords: Allogeneic transplantation; Alternative donor; Cord blood transplantation