Clinical Use of Umbilical Cord Blood Cells

Umbilical cord blood (CB) is an alternative source of hematopoietic stem cells (HSCs) for patients requiring allogeneic HSC transplantation but lacking a suitable human leukocyte antigen (HLA)-matched donor. Using CB has many advantages, including lower HLA-matching requirements, increased donor availability, and low rates of Graft-versus-Host Disease. Furthermore, with over 600,000 cryopreserved volunteer CB units currently stored in international CB banks worldwide, CB is rapidly available for those patients requiring urgent transplantation. However, concern remains over the low HSC doses available in CB grafts, resulting in delayed engraftment and poor immune reconstitution. This chapter will review the current use and future developments of related and unrelated allogeneic CB transplantation. We will provide an overview of the encouraging results of CB transplantation for the treatment of malignant and nonmalignant conditions, both in adults and children. We will discuss the important factors that need to be considered when selecting CB units for transplantation and introduce some of the new developments that are being currently investigated to further improve the results of CB transplantation.