Cord blood cells for clinical use: Expansion and manipulation

Umbilical cord blood (CB) was once considered a medical waste and routinely discarded as part of the afterbirth, however, CB is now commonly used as a source of hematopoietic stem cells for patients undergoing hematopoietic stem cell transplant (HCT) for the treatment of both malignant and nonmalignant disorders. Single institution and registry studies have shown a decreased relapse rate and an increased transplant-related mortality rate with similar overall survival rates after allogeneic HCT with CB when compared to other stem cell sources. The transplantation of double CB units has overcome the dose limitation inherent in a single CB unit and thus has markedly extended the use of CB to larger children and adults. Similarly the use of reduced intensity conditioning in the CB transplant setting allows for treatment of older patients who would be unable to tolerate the myeloablative regimens used in the original CB transplant protocols. During the recent years, there has been exciting progress in the use of CB-derived immune cells in the HCT setting. There are now several strategies being clinically utilized with a goal of reducing graft-versus-host disease and improving CB homing, engraftment and immune reconstitution. These novel approaches, discussed in the following chapter, will likely change the current application of CB transplantation with the goal of producing even better clinical outcomes for our patients.