Ex vivo expansion of cord blood hematopoietic cells

Umbilical cord blood (UCB) provides an alternate source for patients undergoing high dose chemotherapy for treatment of cancer or genetic diseases. In particular, UCB has become a standard therapeutic option for selected patients with hematologic malignancies. Several studies have reported on the use of UCB for transplantation in adult patients, however, low cell doses per cord blood unit have limited the use of CB in this setting due to subsequent delays in engraftment. Ex vivo expansion is one approach that is being explored as a means to provide larger cell numbers from individual UCB products. In addition, recent clinical trials have demonstrated the potential to combine two UCB products to increase the cell dose delivered, however the majority of UCB products with sufficient cell dose, have a one or more antigen mismatch to each other or the recipient. Better matched products are available and ex vivo expansion may increase the cell doses for these products enabling better matched grafts. This chapter will present an overview of past clinical trials and the approaches currently being explored.