Two leading transplant organizations have joined together to publish a report on optimal practices in cord blood transplantation (CBT), including a state-of-the-art clinical “how to” guide on CBT.
The National Marrow Donor Program (NMDP)/Be The Match and the American Society for Blood and Marrow Transplantation (ASBMT) have issued a report based on the best practices at 6 U.S. transplant centers with industry-leading CBT protocols.
The report has specific detailed guidelines on:
- Patient selection
- Graft selection
- GVHD prophylaxis
- Thawing and infusion
- Infection prophylaxis, monitoring, and therapy
- Management of delayed engraftment and graft failure
On graft selection, the authors make specific recommendations on efficiently managing unrelated donor searches and what clinical factors determine whether to prioritize a cord blood graft or a matched or mismatched unrelated donor. Other graft selection topics discussed are cell dose in unit selection, HLA match in unit selection, unit quality, and selection of single-unit versus double-unit cord blood grafts.
New technologies and strategies to enhance myeloid engraftment are discussed, including ex vivo expansion of stem/progenitor cells, enhanced homing using fucosylation, novel conditioning regimens, and novel graft manipulations.
The authors conclude by noting that improving outcomes in CBT have come about through several advances, such as the development of novel conditioning regimens tailored to patient diagnosis and comorbidities, multiple new strategies to speed engraftment, augmented GVHD prophylaxis, prompt GVHD diagnosis and therapy, and improved early treatment of opportunistic infections.