Cytotherapy. 2017 Feb;19(2):272-284. doi: 10.1016/j.jcyt.2016.10.016. Epub 2016 Dec 9.

Lack of impact of umbilical cord blood unit processing techniques on clinical outcomes in adult double cord blood transplant recipients.

Nikiforow S¹, Li S², Snow K³, Liney D⁴, Kao GS⁵, Haspel R⁶, Shpall EJ⁷, Glotzbecker B⁸, Sica RA⁹, Armand P⁸, Koreth J⁸, Ho VT⁸, Alyea EP 3rd⁸, Ritz J⁸, Soiffer RJ⁸, Antin JH⁸, Dey B¹⁰, McAfee S¹⁰, Chen YB¹⁰, Spitzer T¹⁰, Avigan D¹¹, Cutler CS⁸, Ballen K¹⁰.

Abstract

BACKGROUND AIMS:

Despite widespread use of umbilical cord blood (UCB) transplantation and distinct practice preferences displayed by individual UCB banks and transplant centers, little information exists on how processing variations affect patient outcomes.

METHODS:

We reviewed 133 adult double UCB transplants performed at a single center: 98 after reduced-intensity and 35 after myeloablative conditioning. Processing associated with contributing UCB banks and units was surveyed to identify differences in practice. We analyzed effect of selected variables on clinical outcomes of engraftment, dominance, transplant-related mortality, and survival.

RESULTS:

Eighty-eight percent of banks queried currently practice red blood cell (RBC) depletion before cryopreservation. This reflects a shift in practice because previously 65% of banks employed RBC-replete processing methods (i.e., cryopreservation or plasma/volume reduction). Neither neutrophil nor platelet engraftment was affected by processing conditions analyzed. RBC depletion was not associated with clinical outcomes, except in 17 recipients of 2 RBC-replete units, where survival was better than that observed in 116 recipients of ≥1 RBC-depleted units (hazard ratio 3.26, P = 0.004). When analyzed by attributes of the dominant unit, RBC depletion, time in storage, bank years in existence, and inventory size did not affect clinical outcomes. Postthaw viability and CD34 dose were factors impacting engraftment. Notably, all RBC-replete units in this cohort were washed in dextran-human serum albumin before infusion.

DISCUSSION:

These findings support continued utilization of the entire existing pool of cord blood units, despite recent trends in processing, and have important implications for banking resources and UCB selection practices.