THE USE OF UMBILICAL-CORD BLOOD IN MISMATCHED RELATED AND UNRELATED HEMATOPOIETIC STEM-CELL TRANSPLANTATION

Over the past 6 years, umbilical cord blood has emerged as an efficaci ous alternative source of hematopoietic stem cells in related bone mar row transplantation. These encouraging results led us to extend this t echnology to the mismatched related and unrelated settings in three hi gh-risk leukemic children lacking a matched-related donor for transpla ntation. Two of the three children also lacked identifiable donors thr ough the National Marrow Donor Program, while the third was in relapse and did not have time to wait for completion of a search, The first c hild was transplanted with haploidentical umbilical cord blood-derived mononuclear cells from his sister, while the remaining two children w ere transplanted with partially mismatched, unseparated, unrelated umb ilical cord blood banked through the Placental Blood Project at the Ne w York Blood Center, All three children demonstrated trilineage engraf tment with donor cells within 6 weeks of transplantation. The patient transplanted with haploidentical marrow developed grade 2 graft vs, ho st disease (GVHD), which was controlled with steroid and anti-thymocyt e globulin (ATG) therapy, One of the two patients grafted with unrelat ed umbilical cord blood developed mild grade 1 GVHD of the skin, which rapidly cleared with steroid therapy, One patient remains alive, in g ood health and disease-free 12 months from transplantation.