[Cord blood transplantation: current status and future perspectives].

Abstract

Cord blood, which is rich in hematopoietic stem/progenitor cells, is now an important cell source for allogeneic hematopoietic cell transplantation (HCT). Although cord blood transplantation (CBT) was initially only performed in pediatric patients due to the limited number of cells, it now accounts for around 30% of allogeneic HCT for adults in Japan. It has overcome the shortage of donors caused by the declining birthrate and aging population. Although the greatest disadvantage of CBT is the high incidence of Engraftment failure, it has been shown that even in HLA-incompatible recipients, graft-versus-host disease (GVHD) is less frequent and less severe in CBT, whereas the graft-versus-leukemia (GVL) effect is stronger. CBT in Japan differs from that in other countries in that a single-unit is used in adult patients, and CBT is actively performed in elderly patients and patients with advanced hematopoietic disease. Based on the Japanese analysis, the usefulness of intensified conditioning regimen, the survival-improving effect on mild acute or chronic GVHD, and the strong GVL effect are all characteristic of CBT, which is an important source of cells for allogeneic HCT.