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Mulas O, Mola B, Caocci G, La Nasa G. Conditioning Regimens in Patients with β-Thalassemia Who Underwent Hematopoietic Stem Cell Transplantation: A Scoping Review. J Clin Med 2022; 11:jcm11040907. [PMID: 35207178 PMCID: PMC8876955 DOI: 10.3390/jcm11040907] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 01/19/2023] Open
Abstract
The success of transplant procedures in patients with beta-thalassemia major (β-thalassemia) goes hand-in-hand with improvements in disease knowledge, better supportive care, discoveries in immunogenetics, increase in stem cell sources, and enhancement of conditioning regimens. The aim of this scoping review was to report the evolution of conditioning regimes for β-thalassemia hematopoietic stem cell transplantation. We performed a systematic search for all relevant articles published before July 2021, using the following Medical Subject Headings: "bone marrow transplantation", "stem cell transplantation", "allogeneic", "thalassemia", "β-thalassemia", and "thalassemia major". The final analysis included 52 studies, published between 1988 and 2021, out of 3877 records. The most common conditioning regimen was a combination of busulfan and cyclophosphamide, with successive dose adjustments or remodulation based on patient characteristics. Pre-transplant treatments, reductions in cyclophosphamide dosage, or the adoption of novel agents such as treosulphan all improved overall survival and thalassemia-free survival in transplant-related mortality high-risk patients. Conditioning regimes were modulated for those without a suitable fully matched sibling or unrelated donor, with encouraging results. Hematopoietic stem cell transplantation with haploidentical donors is currently available to virtually all patients with β-thalassemia. However, disparities in outcome are still present around the world. In developing and limited-resource countries, where most diagnoses are focused, transplants are not always available. Therefore, more efforts are needed to close this treatment gap.
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Velarde F, Castañeda V, Morales E, Ortega M, Ocaña E, Álvarez-Barreto J, Grunauer M, Eguiguren L, Caicedo A. Use of Human Umbilical Cord and Its Byproducts in Tissue Regeneration. Front Bioeng Biotechnol 2020; 8:117. [PMID: 32211387 PMCID: PMC7075856 DOI: 10.3389/fbioe.2020.00117] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/06/2020] [Indexed: 12/13/2022] Open
Abstract
The fresh or cryopreserved human umbilical cord (HUC) and its byproducts, such as cells and extracts, have different uses in tissue regeneration. Defining what HUC byproduct is more effective in a particular application is a challenge. Furthermore, the methods of isolation, culture and preservation, may affect cell viability and regenerative properties. In this article, we review the HUC and its byproducts' applications in research and clinical practice. We present our results of successful use of HUC as a patch to treat gastroschisis and its potential to be applied in other conditions. Our in vitro results show an increase in proliferation and migration of human fibroblasts by using an acellular HUC extract. Our goal is to promote standardization of procedures and point out that applications of HUC and its byproducts, as well as the resulting advances in regenerative medicine, will depend on rigorous quality control and on more research in this area.
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Affiliation(s)
- Francesca Velarde
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
- Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito, Quito, Ecuador
| | - Verónica Castañeda
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
- Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito, Quito, Ecuador
- Colegio de Ciencias Biológicas y Ambientales, Escuela de Biotecnología, Universidad San Francisco de Quito, Quito, Ecuador
| | - Emilia Morales
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
- Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito, Quito, Ecuador
- Colegio de Ciencias Biológicas y Ambientales, Escuela de Biotecnología, Universidad San Francisco de Quito, Quito, Ecuador
| | - Mayra Ortega
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
- Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito, Quito, Ecuador
- Colegio de Ciencias Biológicas y Ambientales, Escuela de Biotecnología, Universidad San Francisco de Quito, Quito, Ecuador
| | - Edwin Ocaña
- Hospital Carlos Andrade Marín, Quito, Ecuador
| | - Jose Álvarez-Barreto
- Instituto para el Desarrollo de Energías y Materiales Alternativos (IDEMA), Colegio de Ciencias e Ingenierías (Politécnico), Universidad San Francisco de Quito, Quito, Ecuador
| | - Michelle Grunauer
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
- Unidad de Cuidados Intensivos Pediátricos, Hospital de los Valles, Quito, Ecuador
| | - Luis Eguiguren
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
- Sistemas Médicos, SIME, Universidad San Francisco de Quito, Quito, Ecuador
| | - Andrés Caicedo
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
- Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito, Quito, Ecuador
- Sistemas Médicos, SIME, Universidad San Francisco de Quito, Quito, Ecuador
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Rafii H, Bernaudin F, Rouard H, Vanneaux V, Ruggeri A, Cavazzana M, Gauthereau V, Stanislas A, Benkerrou M, De Montalembert M, Ferry C, Girot R, Arnaud C, Kamdem A, Gour J, Touboul C, Cras A, Kuentz M, Rieux C, Volt F, Cappelli B, Maio KT, Paviglianiti A, Kenzey C, Larghero J, Gluckman E. Family cord blood banking for sickle cell disease: a twenty-year experience in two dedicated public cord blood banks. Haematologica 2017; 102:976-983. [PMID: 28302713 PMCID: PMC5451329 DOI: 10.3324/haematol.2016.163055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 03/10/2017] [Indexed: 11/16/2022] Open
Abstract
Efforts to implement family cord blood banking have been developed in the past decades for siblings requiring stem cell transplantation for conditions such as sickle cell disease. However, public banks are faced with challenging decisions about the units to be stored, discarded, or used for other endeavors. We report here 20 years of experience in family cord blood banking for sickle cell disease in two dedicated public banks. Participants were pregnant women who had a previous child diagnosed with homozygous sickle cell disease. Participation was voluntary and free of charge. All mothers underwent mandatory serological screening. Cord blood units were collected in different hospitals, but processed and stored in two public banks. A total of 338 units were stored for 302 families. Median recipient age was six years (11 months-15 years). Median collected volume and total nucleated cell count were 91 mL (range 23-230) and 8.6×108 (range 0.7-75×108), respectively. Microbial contamination was observed in 3.5% (n=12), positive hepatitis B serology in 25% (n=84), and homozygous sickle cell disease in 11% (n=37) of the collections. Forty-four units were HLA-identical to the intended recipient, and 28 units were released for transplantation either alone (n=23) or in combination with the bone marrow from the same donor (n=5), reflecting a utilization rate of 8%. Engraftment rate was 96% with 100% survival. Family cord blood banking yields good quality units for sibling transplantation. More comprehensive banking based on close collaboration among banks, clinical and transplant teams is recommended to optimize the use of these units.
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Affiliation(s)
- Hanadi Rafii
- Eurocord, Paris-Diderot University EA 3518, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Françoise Bernaudin
- Department of Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Paris XII University, Créteil, France
| | - Helene Rouard
- Cell Therapy Facility, EFS Ile de France, Créteil, France
| | - Valérie Vanneaux
- Cell Therapy Facility, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Biotherapy Clinical Investigation Center, Paris-Diderot University, Sorbonne Paris Cité, INSERM, F-75010, France
| | - Annalisa Ruggeri
- Eurocord, Paris-Diderot University EA 3518, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Marina Cavazzana
- Biotherapy Department, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, France
- Biotherapy Clinical Investigation Center, Groupe Hospitalier Universitaire Ouest, Assistance Publique-Hôpitaux de Paris, INSERM, France
- Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, France
| | - Valerie Gauthereau
- Fédération Parisienne Pour le Dépistage et la Prévention des Handicaps de l'Enfant (FPDPHE), Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Aurélie Stanislas
- Biotherapy Department, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, France
- Biotherapy Clinical Investigation Center, Groupe Hospitalier Universitaire Ouest, Assistance Publique-Hôpitaux de Paris, INSERM, France
| | - Malika Benkerrou
- Department of Pediatrics, Referral Center for Sickle Cell Disease, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Mariane De Montalembert
- Department of Pediatrics, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Christele Ferry
- Department of Stem Cell Transplantation, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Robert Girot
- Department of Hemato-Biology, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Cecile Arnaud
- Department of Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Paris XII University, Créteil, France
| | - Annie Kamdem
- Department of Pediatrics, Referral Center for Sickle Cell Disease, Centre Hospitalier Intercommunal, Paris XII University, Créteil, France
| | - Joelle Gour
- Department of Gynecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Claudine Touboul
- Department of Gynecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Audrey Cras
- Cell Therapy Facility, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Biotherapy Clinical Investigation Center, Paris-Diderot University, Sorbonne Paris Cité, INSERM, F-75010, France
| | - Mathieu Kuentz
- Department of Hematology, Groupe Hospitalier Universitaire Henri-Mondor, Créteil, France
| | - Claire Rieux
- Unité d'Hémovigilance, Groupe Hospitalier Universitaire Henri-Mondor, Créteil, France
| | - Fernanda Volt
- Eurocord, Paris-Diderot University EA 3518, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Barbara Cappelli
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Karina T Maio
- Eurocord, Paris-Diderot University EA 3518, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Annalisa Paviglianiti
- Eurocord, Paris-Diderot University EA 3518, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Chantal Kenzey
- Eurocord, Paris-Diderot University EA 3518, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Jerome Larghero
- Cell Therapy Facility, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Biotherapy Clinical Investigation Center, Paris-Diderot University, Sorbonne Paris Cité, INSERM, F-75010, France
| | - Eliane Gluckman
- Eurocord, Paris-Diderot University EA 3518, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, France
- Monacord, International Observatory for Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
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Screnci M, Murgi E, Valle V, Tamburini A, Pellegrini MG, Strano S, Corona F, Ambrogi EB, Girelli G. Sibling cord blood donor program for hematopoietic cell transplantation: the 20-year experience in the Rome Cord Blood Bank. Blood Cells Mol Dis 2016; 57:71-3. [PMID: 26852659 DOI: 10.1016/j.bcmd.2015.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/22/2015] [Accepted: 12/29/2015] [Indexed: 11/25/2022]
Abstract
Umbilical cord blood (UCB) represents a source of hematopoietic stem cells for patients lacking a suitably matched and readily available related or unrelated stem cell donor. As UCB transplantation from compatible sibling provides good results in children therefore directed sibling UCB collection and banking is indicated in family who already have a child with a disease potentially treatable with an allogeneic hematopoietic stem cell transplantation. Particularly, related UCB collection is recommended when the patients urgently need a transplantation. To provide access to all patients in need, we developed a "Sibling cord blood donor program for hematopoietic cell transplantation". Here we report results of this project started 20years ago. To date, in this study a total of 194 families were enrolled, a total of 204 UCB samples were successfully collected and 15 pediatric patients have been transplanted. Recently, some authors have suggested novel role for UCB other than in the transplantation setting. Therefore, future studies in the immunotherapy and regenerative medicine areas could expand indication for sibling directed UCB collection.
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Affiliation(s)
- Maria Screnci
- Immunohaematology and Transfusion Medicine Unit, Azienda Policlinico Umberto I, Via Chieti N 7, 00161 Rome, Italy.
| | - Emilia Murgi
- Immunohaematology and Transfusion Medicine Unit, Azienda Policlinico Umberto I, Via Chieti N 7, 00161 Rome, Italy
| | - Veronica Valle
- Immunohaematology and Transfusion Medicine Unit, Azienda Policlinico Umberto I, Via Chieti N 7, 00161 Rome, Italy
| | - Anna Tamburini
- Immunohaematology and Transfusion Medicine Unit, Ospedale S. Eugenio, P.le dell'Umanesimo n10, 00144 Rome, Italy.
| | - Maria Grazia Pellegrini
- Obstetrics and Gynecology Unit, Ospedale S Giovanni Calibita, Piazza Fatebenefratelli n2, 00186 Rome, Italy.
| | - Sabrina Strano
- Obstetrics and Gynecology Unit, Ospedale S Pertini, Via dei Monti Tiburtini n 385, 00157 Rome, Italy.
| | - Francesca Corona
- Immunohaematology and Transfusion Medicine Unit, Azienda Policlinico Umberto I, Via Chieti N 7, 00161 Rome, Italy
| | - Eleonora Barbacci Ambrogi
- Immunohaematology and Transfusion Medicine Unit, Azienda Policlinico Umberto I, Via Chieti N 7, 00161 Rome, Italy
| | - Gabriella Girelli
- Immunohaematology and Transfusion Medicine Unit, Azienda Policlinico Umberto I, Via Chieti N 7, 00161 Rome, Italy
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5
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Screnci M, Murgi E, Tamburini A, Pecci MR, Ballatore G, Cusanno A, Valle V, Luciani P, Corona F, Girelli G. Family directed umbilical cord blood banking for acute leukemia: usage rate in hematopoietic stem cell transplantation. Stem Cell Rev Rep 2016; 11:275-9. [PMID: 25504378 DOI: 10.1007/s12015-014-9579-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Family-directed umbilical cord blood (UCB) collection and banking is indicated in women delivering healthy babies who already have a member of their own family with a disease potentially treatable with an allogeneic hematopoietic stem cell (HSCs) transplantation (HSCT). The rapid availability of UCB is an important issue in HSCs procurement particularly for recipients with acute leukemia who urgently need HSCT. The aims of this study were to assess the usage rate of family UCB collections directed to patients with acute leukemia and to investigate the factors influencing the usage rate. A total of 113 families were enrolled, 118 UCB units were successfully collected and one collection failed due to emergency occurred during delivery. Among these, 7 collections were required for children who were in urgent need of a transplant: three HLA-matched units were successfully transplanted, respectively after 2, 5 and 6 months from collection; three collections resulted HLA-mismatched, while HLA-typing is pending for one unit. The remaining collections were mostly required for potential future use, among these units only one was transplanted in a HLA compatible sibling after 3 years and 4 months from collection. After a median time of storage of 8.5 years (range 0.1-20 years) a total of 4/118 (3.4 %) collection has been transplanted. During this time interval, considering only patients who have had the need of a transplant, the main factor influencing low utilization rate of UCB collections was due to HLA disparity, indeed among typed UCB unit mostly (77 %) resulted HLA mismatched with the intended recipient.
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Affiliation(s)
- M Screnci
- Department of Immunoematologia e Medicina Trasfusionale, Azienda Policlinico Umberto I, Via Chieti N°7, 00161, Rome, Italy,
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Lu H, Chen Y, Lan Q, Liao H, Wu J, Xiao H, Dickerson CA, Wu P, Pan Q. Factors That Influence a Mother's Willingness to Preserve Umbilical Cord Blood: A Survey of 5120 Chinese Mothers. PLoS One 2015; 10:e0144001. [PMID: 26650509 PMCID: PMC4674096 DOI: 10.1371/journal.pone.0144001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/20/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Umbilical Cord blood (UCB), which contains a substantive number of stem cells, could be widely used in transplants to treat a variety of oncologic, genetic, hematologic, and immunodeficiency disorders. However, only a small portion of mothers preserve or donate their UCB in China. The limited availability of UCB has hampered stem cell research and therapy nowadays. To date, no systemic investigations regarding factors that influence a mother's willingness to preserve UCB have been performed in China. In the current study, we are trying to determine those factors which will provide useful information for national health policy development and will raise awareness of the importance of UCB preservation. METHODS During 2011 to 2013, 5120 mothers with the average age of 26.1±8.4 years were included in this study. Those mothers participated in a standardized survey. The information gathered consisted of delivery time, occupation, level of education, knowledge of preservation of UCB, willingness to store UCB, and related concerns. The results have been analyzed with SPSS 16.0. RESULTS The results showed that first-time mothers showed a greater willingness to preserve their UCB (73.3%) compared to those having their second (48.9%) or third child (40.3%). Mothers who were employed at Government Agencies and Organizations were more willing to preserve their UCB (87.3%) than those employed at factories (62.0%), and those who were unemployed (27.3%). Mothers holding master's or college degrees were more willing to preserve their UCB (72.5% and 71.1%, respectively) than mothers with high school diplomas (48.7%) or those who only went to preliminary school or middle school (40.7%). The two strongest factors that influenced an unwillingness to preserve UCB were the high cost and concerns regarding the safety of the preservation. CONCLUSIONS The results showed that mothers with higher education or those having better occupations are more likely to preserve their UCB in China. These mothers have related knowledge and understand the importance of the preservation and they could more readily afford the relatively high cost. The government, clinicians and UCB banks should combine efforts to take measures, such as increasing public knowledge of the importance of UCB preservation and decreasing the high cost for its storage will most likely increase the frequency of UCB preservation which will further benefit stem cell research and therapy.
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Affiliation(s)
- Haiyan Lu
- Clinical Research Center & Institute of Nephrology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - Yanwen Chen
- Clinical Research Center & Institute of Nephrology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - Qiaofen Lan
- Clinical Research Center & Institute of Nephrology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - Huanjin Liao
- Clinical Research Center & Institute of Nephrology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - Jing Wu
- Clinical Research Center & Institute of Nephrology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - Haiyan Xiao
- Department of Anesthesiology & Perioperative Medicine, Georgia Regents University, Augusta, Georgia, United States of America
| | - Carol A. Dickerson
- Department of Anesthesiology & Perioperative Medicine, Georgia Regents University, Augusta, Georgia, United States of America
| | - Ping Wu
- Clinical Research Center & Institute of Nephrology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
- * E-mail: (PW); (QP)
| | - Qingjun Pan
- Clinical Research Center & Institute of Nephrology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
- * E-mail: (PW); (QP)
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Navarrete C. Cord Blood Banking. CORD BLOOD STEM CELLS AND REGENERATIVE MEDICINE 2015. [PMCID: PMC7150031 DOI: 10.1016/b978-0-12-407785-0.00015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Petrini C. Umbilical cord blood banking: from personal donation to international public registries to global bioeconomy. J Blood Med 2014; 5:87-97. [PMID: 24971040 PMCID: PMC4069132 DOI: 10.2147/jbm.s64090] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The procedures for collecting voluntarily and freely donated umbilical cord blood (UCB) units and processing them for use in transplants are extremely costly, and the capital flows thus generated form part of an increasingly pervasive global bioeconomy. To place the issue in perspective, this article first examines the different types of UCB biobank, the organization of international registries of public UCB biobanks, the optimal size of national inventories, and the possibility of obtaining commercial products from donated units. The fees generally applied for the acquisition of UCB units for transplantation are then discussed, and some considerations are proposed regarding the social and ethical implications raised by the international network for the importation and exportation of UCB, with a particular emphasis on the globalized bioeconomy of UCB and its commerciality or lack thereof.
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Giannopoulou EZ, Puff R, Beyerlein A, von Luettichau I, Boerschmann H, Schatz D, Atkinson M, Haller MJ, Egger D, Burdach S, Ziegler AG. Effect of a single autologous cord blood infusion on beta-cell and immune function in children with new onset type 1 diabetes: a non-randomized, controlled trial. Pediatr Diabetes 2014; 15:100-9. [PMID: 24102806 DOI: 10.1111/pedi.12072] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 07/21/2013] [Accepted: 07/30/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The application of autologous cord blood in children with type 1 diabetes has been found to be safe, but not to preserve beta-cell function in a previous study, which, however, had not included a control group. OBJECTIVE To compare the changes of metabolic and immune function over time between cord blood infused children and natural controls. SUBJECTS AND METHODS Seven children with newly diagnosed type 1 diabetes underwent a single autologous cord blood infusion and 10 children were enrolled as natural controls in a non-randomized, controlled, open label intervention trial. Primary analyses were performed 1 year following cord blood infusion. Cases and controls were compared regarding metabolic [area under the curve (AUC) and peak C-peptide, insulin use, and HbA1c] and immune outcome (islet autoantibody titer and T-cell response), adjusted for age, gender, diabetes duration, and baseline levels. RESULTS There were no significant adverse events related to the infusion. Metabolic and immune outcomes were not significantly different at 12 months follow-up between infused children and controls (e.g., adjusted p = 0.244 for AUC C-peptide, adjusted p = 0.820 for insulin use, adjusted p = 0.772 for peripheral regulatory T cells). Six-month change of AUC C-peptide correlated significantly with the number of infused CD34+ cells (r = 0.931, p = 0.002). CONCLUSIONS An autologous cord blood infusion does not change the natural course of metabolic and immune parameters after disease onset. However, the content of CD34+ cells in the stored blood sample might offer potential for improvement of future cell therapies.
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Affiliation(s)
- Eleni Z Giannopoulou
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, 85764, Neuherberg, Germany; Forschergruppe Diabetes e.V., 85764, Neuherberg, Germany
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Portillo V, Chadwick N, Lloyd R, Jackson D, Buckle AM. Cell-surface Notch1 expression identifies a primitive phenotype within CD34+ CD38- haematopoietic cells. Eur J Haematol 2013; 92:26-34. [PMID: 24010734 DOI: 10.1111/ejh.12200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Notch signalling has been implicated in haematopoietic stem cell self-renewal. Although several studies have tested the effect of activating or inhibiting the Notch signalling pathway in stem cells, no study has yet determined the functional differences associated with expressing Notch1. The aims of this study were to characterise the expression of human cell-surface Notch1 in cord blood (CB) CD34(+) cells and to study the function of Notch in CD34(+) cells in vitro. METHODS A monoclonal antibody against the extracellular domain of Notch1 was developed, and Notch1 expression in CB CD34(+) cells was assessed by flow cytometry. CB CD34(+) cells were sorted on the basis of their Notch1 expression and cultured in serum-free media. Single sorted CD34(+) CD38(-) Notch1(+) /(-) cells were cultured for 8 wks on murine stroma monolayers and assayed for stem cell activity and lineage potential using a cobblestone area-forming cell (CAFC) assay. RESULTS Cell-surface Notch1 expression was characterised in various primitive CD34(+) cell compartments including a small subpopulation of CD34(+) CD38(-) cells. We found the CD34(+) CD38(-) Notch1(+) population to be enriched for stem cell activity. Moreover, CD34(+) CD38(-) Notch1(+) , but not Notch1(-) cells, demonstrated multilineage potential. CONCLUSIONS These data show that Notch1 is expressed on a functionally distinct subpopulation of CD34(+) cells that is highly enriched for stem cell activity and multilineage potential and could suggest that Notch1 could be used as a novel stem cell marker.
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11
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Petrini C. Ethical issues in umbilical cord blood banking: a comparative analysis of documents from national and international institutions. Transfusion 2012; 53:902-10. [DOI: 10.1111/j.1537-2995.2012.03824.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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A comparative analysis of the opinions from European national and international ethics committees regarding the collection, storage and use of umbilical cord blood. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2012; 10:279-89. [PMID: 22337278 DOI: 10.2450/2012.0172-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 01/17/2012] [Indexed: 02/04/2023]
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Gluckman E, Ruggeri A, Rocha V, Baudoux E, Boo M, Kurtzberg J, Welte K, Navarrete C, van Walraven SM. Family-directed umbilical cord blood banking. Haematologica 2011; 96:1700-7. [PMID: 21750089 PMCID: PMC3208689 DOI: 10.3324/haematol.2011.047050] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 06/16/2011] [Accepted: 06/30/2011] [Indexed: 01/21/2023] Open
Abstract
Umbilical cord blood transplantation from HLA-identical siblings provides good results in children. These results support targeted efforts to bank family cord blood units that can be used for a sibling diagnosed with a disease which can be cured by allogeneic hematopoietic stem cell transplantation or for research that investigates the use of allogeneic or autologous cord blood cells. Over 500 patients transplanted with related cord blood units have been reported to the Eurocord registry with a 4-year overall survival of 91% for patients with non-malignant diseases and 56% for patients with malignant diseases. Main hematologic indications in children are leukemia, hemoglobinopathies or inherited hematologic, immunological or metabolic disorders. However, family-directed cord blood banking is not widely promoted; many cord blood units used in sibling transplantation have been obtained from private banks that do not meet the necessary criteria required to store these units. Marketing by private banks who predominantly store autologous cord blood units has created public confusion. There are very few current validated indications for autologous storage but some new indications might appear in the future. Little effort is devoted to provide unbiased information and to educate the public as to the distinction between the different types of banking, economic models and standards involved in such programs. In order to provide a better service for families in need, directed-family cord blood banking activities should be encouraged and closely monitored with common standards, and better information on current and future indications should be made available.
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Affiliation(s)
- Eliane Gluckman
- Eurocord, Hospital Saint Louis, University Paris VII, Paris, France.
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14
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Effects of obstetric factors and storage temperatures on the yield of endothelial colony forming cells from umbilical cord blood. Angiogenesis 2011; 14:381-92. [PMID: 21720855 PMCID: PMC3155043 DOI: 10.1007/s10456-011-9222-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 06/16/2011] [Indexed: 11/08/2022]
Abstract
As umbilical cord blood (UCB) is a rich source of endothelial colony-forming cells (ECFC), our aim was twofold: (1) to examine potential obstetric selection criteria for achieving the highest ECFC yields from UCB units, and (2) to determine whether transient storage temperatures of fresh UCB and cryopreservation of UCB units affected ECFC yield and function. ECFC quality was assessed before and after cryopreservation by their clonogenic proliferative potential. Of the 20 factors examined, placental weight was the only statistically significant obstetric factor that predicted ECFC frequency in UCB. Studies on the effects of storage revealed that transient storage of fresh UCB at 4°C reduced ECFC yield compared with storage at 22°C, while cryopreservation of UCB MNCs significantly reduced ECFC recoveries. To our knowledge, this is the first demonstration that placental weight and temperature of storage prior to processing or culture have significant effects on ECFC frequency in UCB. Our studies further support the evidence that cryopreservation of UCB MNCs compromises ECFC recovery.
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Butler MG, Menitove JE. Umbilical cord blood banking: an update. J Assist Reprod Genet 2011; 28:669-76. [PMID: 21617932 DOI: 10.1007/s10815-011-9577-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 04/29/2011] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Umbilical cord blood is a potential vast source of primitive hematopoietic stem and progenitor cells available for clinical application to reconstitute the hematopoietic system and/or restore immunological function in affected individuals requiring treatment. Cord blood can be used as an alternative source for bone marrow transplantation and its use is developing into a new field of treatment for pediatric and adult patients presenting with hematological disorders, immunological defects and specific genetic diseases. DISCUSSION More than 25,000 allogeneic cord blood transplantations have been performed worldwide since the first cord blood transplantation in 1988. There are two banking options for storing umbilical cord blood [private (family) and public]. Cord blood stored in private banks are used for either autologous or allogeneic transplants for the infant donor or related family members but private cord blood banks are not searchable or available to the public. More than 780,000 cord blood units are stored in over 130 private cord blood banks, worldwide, and over 400,000 units in more than 100 quality controlled public cord blood banks. CONCLUSIONS Researchers continue to evaluate the usefulness of cord blood cells in treating human diseases or disorders for purposes other than hematological disorders including heart disease, strokes, brain or spinal cord injuries and cancer. This review summarizes the status of umbilical cord blood banking, its history and current and potential use in the treatment of human disease.
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Affiliation(s)
- Merlin G Butler
- Departments of Psychiatry & Behavioral Sciences and Pediatrics, Kansas University Medical Center, Kansas City, KS 66160, USA.
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16
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Challenges in umbilical cord blood stem cell banking for stem cell reviews and reports. Stem Cell Rev Rep 2010; 6:8-14. [PMID: 19997789 DOI: 10.1007/s12015-009-9105-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Twenty years has passed since the first report of a successful cord blood transplant was reported in 1989 in a child with Fanconi's anemia. During these 20 years, the cord blood field has had dramatic growth, with over 400,000 cord blood units donated and stored worldwide for unrelated use. Approximately, 14,000 unrelated cord blood transplants have been performed to date for patients with hematologic malignancies and bone marrow disorders, and who do not have matched family or unrelated donors. In contrast, about 900,000 cord blood units have been stored privately for personal use, with about 100 autologous transplants performed. Twenty years ago, due to the low cell dose, cord blood transplants were only performed in children. Today, with the use of better banking techniques, reduced intensity transplants, and double cord blood transplantation, the majority of cord blood transplants are being performed in adults. In this chapter, we review the scientific basis for cord blood transplantation, and outcome data in both pediatric and adult transplantation. We will then focus on the recent concerns regarding private and public cord blood banking. Finally, we discuss the future of cord blood transplantation, and the exciting work beginning outside of oncology.
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17
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Long-term follow-up and factors influencing outcomes after related HLA-identical cord blood transplantation for patients with malignancies: an analysis on behalf of Eurocord-EBMT. Blood 2010; 116:1849-56. [PMID: 20538797 DOI: 10.1182/blood-2010-02-271692] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We analyzed risk factors influencing outcomes after related (R) human leukocyte antigen-identical cord blood transplantation (CBT) for 147 patients with malignancies reported to Eurocord-European Group for Blood and Marrow Transplantation. CBT has been performed since 1990; median follow-up was 6.7 years. Median patient age was 5 years. Acute leukemia was the most frequent diagnosis (74%). At CBT, 40 patients had early, 70 intermediate, and 37 advanced disease. CB grafts contained a median of 4.1 × 10(7)/kg total nucleated cells (TNCs) after thawing. The cumulative incidence (CI) of neutrophil recovery was 90% at day +60. CIs of acute and chronic graft-versus-host disease (GVHD) were 12% and 10% at 2 years, respectively. At 5 years, CIs of nonrelapse mortality and relapse were 9% and 47%, respectively; the probability of disease-free survival (DFS) and overall survival were 44% and 55%, respectively. Among other factors, higher TNCs infused was associated with rapid neutrophil recovery and improved DFS. The use of methotrexate as GVHD prophylaxis decreased the CI of engraftment. Patients without advanced disease had improved DFS. These results support banking and use of CB units for RCBT. Cell dose, GVHD prophylaxis not including methotrexate, and disease status are important factors for outcomes after RCBT.
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18
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Screnci M, Murgi E, Carmini D, Piro L, Cinelli N, Laurenti L, Iori AP, Simone F, Massari S, Girelli G. Related cord blood banking for haematopoietic stem cell transplantation. Transfus Med 2010; 20:185-90. [DOI: 10.1111/j.1365-3148.2009.00983.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Directed sibling donor cord blood banking for children with beta-thalassemia major in Greece: usage rate and outcome of transplantation for HLA-matched units. Blood Cells Mol Dis 2010; 44:107-10. [PMID: 19931473 DOI: 10.1016/j.bcmd.2009.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2009] [Revised: 10/20/2009] [Accepted: 10/21/2009] [Indexed: 11/22/2022]
Abstract
Several cord blood banks store cord blood units from healthy siblings of patients, who are candidates for stem cell transplantation. We analyzed the quality characteristics of 50 cord blood units collected from families with beta-thalassemia major and the outcome of subsequent stem cell transplantations during a 15-year period. All cord blood units were found suitable for banking based on a minimum net volume of 40 ml. The mean volume of the units was 98.9 ml; the mean total nucleated cell count (NC) was 7.8 x 10(8) and the mean CD34+ cell count was 2.8 x 10(6). Eight out of twelve HLA matched collections were released for transplantation. All but one recipient belonged to Pesaro II-III risk classes. Three patients received a cord blood graft with >5 x 10(7) NC/kg . One of them with Pesaro class I disease engrafted, whereas the other two who failed to engraft, were re-transplanted with bone marrow from the same donor later. Cord blood grafts containing NCs <4 x 10(7)/kg combined with reduced volume bone marrow from the same donor were used in all 5 remaining cases and stable engraftment was achieved. All patients survived, 7/8 thalassemia-free. Cord blood banking from healthy siblings of children with beta-thalassemia major can result in a successful transplantation in cases in which there is HLA compatibility. However, in high-risk patients, the use of combined cord blood and bone marrow grafts seems necessary in order to ensure stable engraftment, especially when cord blood unit cell counts are low.
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Peters C, Cornish JM, Parikh SH, Kurtzberg J. Stem cell source and outcome after hematopoietic stem cell transplantation (HSCT) in children and adolescents with acute leukemia. Pediatr Clin North Am 2010; 57:27-46. [PMID: 20307710 DOI: 10.1016/j.pcl.2010.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation from siblings, unrelated donors or HLA mismatched family members has become an important procedure to offer a chance of cure to children and adolescents with acute leukemia at high risk of relapse and those with certain genetic diseases. Bone marrow (BM) was the only stem cell source for many years. During the past 15 years, peripheral blood stem cells from granulocyte colony-stimulating factor (G-CSF) mobilized healthy donors, or umbilical cord blood from related or unrelated donors, have become available. Each stem cell source has different risks/benefits for patients and donors, the choice depending not only on availability, but also on HLA compatibility and urgency of the HSCT. This review will analyze the advantages and limitations of each of these options, and the main criteria which can be applied when choosing the appropriate stem cell source for pediatric transplant recipients with acute leukemia.
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Affiliation(s)
- Christina Peters
- Stem Cell Transplantation Unit, St Anna Children's Hospital, Kinderspitalgasse 6, A-1090 Vienna, Austria.
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Abstract
The therapeutic potential of 'adult' or at least non-embryonic stem cells and their progeny has developed gradually over the past half century as a consequence of the wealth of knowledge derived from stem cell research. Translational research coupled with clinical trials and derived from basic research has led the way to the clinic. This commenced with the use of haematopoietic stem cell transplantation (HSCT), to treat haematological malignancies, to be followed by the most recent clinical trials to treat a variety of coronary and peripheral artery diseases. Stem cells and their progeny isolated from bone marrow or blood appear to exert an ameliorating effect in certain vascular disorders. Although promising, some of these treatments remain controversial and further research and, where indicated, appropriately powered trials are required to confirm the safety and determine the efficacy of these novel therapies.
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Affiliation(s)
- E Martin-Rendon
- Stem Cell Research Laboratory, NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK.
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23
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Austin EB, Guttridge M, Pamphilon D, Watt SM. The role of blood services and regulatory bodies in stem cell transplantation. Vox Sang 2008; 94:6-17. [PMID: 18171327 DOI: 10.1111/j.1423-0410.2007.00974.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Advances in stem cell research over the past few decades have coincided with large increases in haemopoietic stem cell transplantation (HSCT) using either bone marrow, peripheral blood or cord blood-derived stem cells. Alongside this growth has come an increase in the role played by regulatory bodies, both governmental and professional, to ensure that those undertaking such procedures do so in a manner so as to minimize the risk to patients. Interestingly, government legislation encompasses not only cellular therapies, but also the use of tissues and organs, as many of the processes and procurement procedures involved are similar. In this review, we analyse the trends in HSCT, describe the development and impact of legislation within Europe on this practice and outline the vital role played by the UK blood services in providing robust and high-quality HSCT services.
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Affiliation(s)
- E B Austin
- Stem Cells and Immunotherapies, National Blood Service - Manchester, National Health Service Blood and Transplant, Manchester, UK.
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Affiliation(s)
- Nicholas M Fisk
- Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN.
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25
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Abstract
Despite improvements in supportive care, patients with beta-thalassaemia major or sickle cell disease (SCD) may benefit from haematopoietic stem cell transplantation at some point during their lives. Human leucocyte antigen (HLA)-matched sibling bone marrow donors are not always available and alternative sources of stem cells have been sought, including related and unrelated donor cord blood transplants (CBT). The outcome of CBT from related donors for the treatment of both thalassaemia major and SCD is now approaching that for bone marrow transplantation, with around 90% of patients surviving disease-free. The main complication is graft rejection, which may be reduced by increasing pretransplant immune suppression. Transplant-related mortality following HLA-identical matched related donor CBT is extremely low but is significant in the small series of unrelated and/or mis-matched donor CBT. The principal limitation to extending the use of CB stem cells for the cure of haemoglobinopathies is the need to better understand the mechanisms of action and optimal conditioning regimens used to secure long-term engraftment while minimizing morbidity and mortality. Further biological studies and clinical trials are needed to address this aim.
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Affiliation(s)
- Fernando O Pinto
- Department of Paediatric Haematology, Imperial College Healthcare NHS Trust, London, UK
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