Optimal Practices in Unrelated Donor Cord Blood Transplantation for Hematologic Malignancies

Juliet N. Barker, Joanne Kurtzberg, Karen Ballen, Michael Boo, Claudio Brunstein, Corey Cutler, Mitchell Horwitz, Filippo Milano, Amanda Olson, Stephen Spellman, John E. Wagner, Colleen Delaney, Elizabeth Shpall

Research output: Contribution to journalReview article

42 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)882-896
Number of pages15
JournalBiology of Blood and Marrow Transplantation
Volume23
Issue number6
DOIs
StatePublished - Jun 2017

Keywords

  • Allogeneic transplantation
  • Alternative donor
  • Cord blood transplantation

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    Barker, J. N., Kurtzberg, J., Ballen, K., Boo, M., Brunstein, C., Cutler, C., Horwitz, M., Milano, F., Olson, A., Spellman, S., Wagner, J. E., Delaney, C., & Shpall, E. (2017). Optimal Practices in Unrelated Donor Cord Blood Transplantation for Hematologic Malignancies. Biology of Blood and Marrow Transplantation, 23(6), 882-896. https://doi.org/10.1016/j.bbmt.2017.03.006