The Use of Back-up Units to Enhance the Safety of Unrelated Donor Cord Blood Transplantation

The inability to obtain additional stem cells is a disadvantage of unrelated donor cord blood transplantation (CBT). Moreover, in the event of problems with unit shipment, compromised unit quality, thaw mishaps, or graft failure, the time to secure a back-up graft could be unacceptable. Emergent shi...

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Bibliographic Details
Published in:Biology of blood and marrow transplantation 2012-04, Vol.18 (4), p.648-651
Main Authors: Ponce, Doris M, Lubin, Marissa, Gonzales, Anne Marie, Byam, Courtney, Wells, Deborah, Ferrante, Rosanna, Heller, Glenn, Giralt, Sergio, Papadopoulos, Esperanza B, Kernan, Nancy A, Scaradavou, Andromachi, Barker, Juliet N
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Child
Child, Preschool
Cord Blood Stem Cell Transplantation
Cord blood transplantation
Double unit graft
Female
Graft failure
Graft Rejection - immunology
Graft Rejection - therapy
Graft vs Host Disease - immunology
Graft vs Host Disease - prevention & control
Hematology, Oncology and Palliative Medicine
Histocompatibility Testing
Humans
Infant
Lymphoproliferative Disorders - immunology
Lymphoproliferative Disorders - therapy
Male
Middle Aged
Retrospective Studies
Specimen Handling
Transplantation Conditioning
Transplantation, Homologous
Transplants - supply & distribution
Unrelated Donors
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Summary:The inability to obtain additional stem cells is a disadvantage of unrelated donor cord blood transplantation (CBT). Moreover, in the event of problems with unit shipment, compromised unit quality, thaw mishaps, or graft failure, the time to secure a back-up graft could be unacceptable. Emergent shipment of 1 to 2 back-up units that have been previously typed and reserved could overcome this limitation. However, the advantages of this approach are not established. Therefore, we present our use of back-up units over a 5.5-year period. Six of 121 CBT recipients (5%) required back-up unit infusion. Indications included shipment mishaps (n = 2), poor unit viability (n = 2), significant infusion reaction (n = 1), and graft failure (n = 1). Lack of back-up units would have caused transplantation delay or infusion of inferior-quality units. Five of the 6 patients achieved sustained donor engraftment. We demonstrate that back-up units are emergently required in a significant minority of patients, supporting the incorporation of at least 1 back-up unit in cord blood (CB) selection algorithms to enhance CBT safety.
ISSN:1083-8791
1523-6536
DOI:10.1016/j.bbmt.2011.12.588