Advances in umbilical cord blood manipulation-from niche to bedside

Troy C. Lund, Anthony E. Boitano, Colleen S. Delaney, Elizabeth J. Shpall, John E. Wagner

Research output: Contribution to journalReview articlepeer-review

46 Scopus citations

Abstract

The use of umbilical cord blood (UCB) as an alternative haematopoietic cell source in lieu of bone marrow for haematopoietic reconstitution is increasingly becoming a mainstay treatment for both malignant and nonmalignant diseases, as most individuals will have at least one available, suitably HLA-matched unit of blood. The principal limitation of UCB is the low and finite number of haematopoietic stem and progenitor cells (HSPC) relative to the number found in a typical bone marrow or mobilized peripheral blood allograft, which leads to prolonged engraftment times. In an attempt to overcome this obstacle, strategies that are often based on native processes occurring in the bone marrow microenvironment or 'niche' have been developed with the goal of accelerating UCB engraftment. In broad terms, the two main approaches have been either to expand UCB HSPC ex vivo before transplantation, or to modulate HSPC functionality to increase the efficiency of HSPC homing to the bone marrow niche after transplant both of which enhance the biological activities of the engrafted HSPC. Several early phase clinical trials of these approaches have reported promising results.

Original languageEnglish (US)
Pages (from-to)163-174
Number of pages12
JournalNature Reviews Clinical Oncology
Volume12
Issue number3
DOIs
StatePublished - Mar 28 2015

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