Cord blood benefits and use considerations

While cord blood unit selection and use include different considerations than adult related and unrelated donors, it continues to be a valuable graft source for clinicians to consider early in the search process. This is especially true for patients with a low likelihood of a 10/10 related or unrelated donor, from diverse ethnic backgrounds and those who need transplants quickly.

Benefits of cord blood as a graft source

Cord blood as a graft source offers many potential benefits to patients from expanding the donor pool to more patients in need and, delivering speed to transplant, to lower incidence of chronic graft-versus-host disease (cGVHD) and greater graft-versus-leukemia effect – all which can lead to long term quality life.

Transplant availability for more patients

The naivety of cord blood stem cell’s make them uniquely tolerant to HLA disparity, allowing for greater matching flexibility. This extends the availability of transplant to more patients, including those who are ethnically diverse.

55% - more than 148,000 - of umbilical cord blood units (CBUs) on the NMDP Registry^SM are ethnically diverse.

Related research:

• Availability of cord blood extends allogeneic hematopoietic stem cell transplant access to racial and ethnic minorities (Barker JN, et al., Biol Blood Marrow Transplant, 2010)
• HLA match likelihoods for hematopoietic stem-cell grafts in the U.S. registry (Gragert N, et al., N Engl J Med, 2014)
• The influence of stem cell source on transplant outcomes for pediatric patients with acute myeloid leukemia (Keating AK, et al., Blood Advances, 2019)
• High progression-free survival after intermediate intensity double unit cord blood transplantation in adults (Barker JN, et al., Blood Advances, 2020)

Speed to transplant

For diseases in which speed to transplant is critical, cord blood units allow for rapid deliverability. With CBUs already cryopreserved, typed and disease tested, transplant centers can typically acquire a cord blood unit in weeks rather than months with marrow or PBSC from an unrelated adult donor.

Related research:

• Outcomes of UCB transplantation are comparable in FLT3+ AML: results of CIBMTR, EUROCORD and EBMT collaborative analysis (Ustun C, et al., Leukemia)

Chronic graft-versus-host disease incidence

Chronic GVHD after transplant is a well-known complication after allogeneic transplant that can impact patient outcomes and quality-of-life. Some research has shown that patients who receive cord blood as a graft source experience a lower incidence of cGVHD or less severe cGVHD.

Related research:

• GVHD after umbilical cord blood transplantation for acute leukemia: an analysis of risk factors and effect on outcomes (Chen Y-B, et al., Bone Marrow Transplant, 2016)
• Risk factors for acute and chronic graft-versus-host disease after allogeneic hematopoietic cell transplantation with umbilical cord blood and matched sibling donors (Lazaryan A, et al., Biol Blood Marrow Transplant, 2016)

“For me, the number one benefit of cord blood transplantation is the marked decrease in chronic graft-versus-host disease that cord blood patients have after their transplant, presuming everything else is going well. That is probably the number one, two and three reason why we are such big fans of cord blood.”

Jonathan Gutman, MD
Director, Allogeneic Stem Cell Transplant
UCHealth University of Colorado Hospital

Graft-versus-leukemia effect

Patients with acute leukemias who have minimal residual disease pre-transplant may benefit from cord blood. Published research shows some evidence that graft-versus leukemia effects seems to be stronger with cord blood than other donor sources.

“Cord blood is a great option that really should be considered in line with the other donor sources. It shouldn't be considered a second or third or fourth choice for patients. That’s especially true for pediatric patients where we're trying to provide them with quality of life for decades to come as well as curing their disease.”

Kristin Page, MD
Assistant Professor of Pediatrics, Pediatric Transplant and Cellular Therapy
Duke University Medical Center

Related research:

• Cord-blood transplantation in patients with minimal residual disease (Milano F, et al., N Engl J Med, 2016)

“Yes, [cord blood transplant] takes experience. But every kind of transplant really has some sort of experience necessary to do it well. I don't think that should be a drawback from choosing cord blood as a graft source.”

Leland Metheny, MD
University Hospitals Seidman Cancer Center