Cord blood transplantation: Evolving strategies to improve engraftment and immune reconstitution

Maricer P. Escalón, Krishna V. Komanduri

Research output: Contribution to journalReview article

29 Scopus citations

Abstract

Purpose of Review: For many patients with relapsed or high-risk hematologic malignancies, allogeneic stem cell transplantation offers the best hope for cure. For patients lacking a suitable family or unrelated donor, umbilical cord blood provides a promising alternative graft source. Dramatic advances in cord blood transplantation (CBT) have been made in the past 2 decades, leading to a rapid expansion of CBT programs worldwide. Recent Findings: Promising new strategies, including double CBT and ex-vivo graft engineering, have improved myeloid and platelet engraftment rates and kinetics. However, delayed immune reconstitution and associated infectious morbidity and mortality remain a significant challenge, especially in adult CBT recipients. In adults, both impaired recipient thymopoiesis and the lack of transferred memory cells contribute to delayed T cell recovery, resulting in an increased risk of opportunistic infections. Summary: Novel clinical approaches in CBT have improved outcomes, especially those associated with delays in myeloid and platelet engraftment. However, delayed immune reconstitution remains a great challenge. Novel strategies, including graft engineering approaches capable of improving T cell recovery, and pharmacologic interventions capable of preserving thymopoiesis and facilitating the recovery of a diverse functional T cell repertoire are being pursued; these approaches have great potential to further improve outcomes after CBT.

Original languageEnglish (US)
Pages (from-to)122-129
Number of pages8
JournalCurrent opinion in oncology
Volume22
Issue number2
DOIs
StatePublished - Mar 1 2010

Keywords

  • Cord blood transplantation
  • Immune reconstitution
  • Opportunistic infection
  • Thymopoiesis

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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