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1.
Stem Cells Dev ; 30(15): 773-781, 2021 08 01.
Article in English | MEDLINE | ID: mdl-34044609

ABSTRACT

Previously, we demonstrated the therapeutic effects of human umbilical cord mesenchymal stromal cells (hUC-MSCs) in severe coronavirus disease 2019 (COVID-19) patients. In this 3-month follow-up study, we examined discharged patients who had received hUC-MSC therapy to assess the safety of this therapy and the health-related quality of life (HRQL) of these patients. The follow-up cohort consisted of 28 discharged severe COVID-19 patients who received either the standard treatment (the control group) or the standard treatment plus hUC-MSC therapy. We examined liver function, kidney function, pulmonary function, coagulation, tumor markers, and vision. We also conducted electrocardiography (ECG) analysis, let the patients answer the St. George's Respiratory Questionnaire (SGRQ), and performed computed tomography (CT) imaging for assessing the lung changes. No obvious adverse effects were observed in the hUC-MSC group after 3 months. Measurements of blood routine index, C-reactive protein and procalcitonin, liver and kidney function, coagulation, ECG, tumor markers, and vision were almost within the normal ranges in both the treatment and control groups. Forced expiratory volumes in 1 s (FEV1) (% of predicted) were 71.88% ± 8.46% and 59.45% ± 27.45% in the hUC-MSC and control groups (P < 0.01), respectively, and FEV1/forced vital capacity (FEV1/FVC) ratios were 79.95% ± 8.00% and 58.97% ± 19.16% in the hUC-MSC and control groups, respectively (P < 0.05). SGRQ scores were lower in the hUC-MSC group than in the control group (15.25 ± 3.69 vs. 31.9 ± 8.78, P < 0.05). The rate of wheezing in the hUC-MSC group was also significantly lower than that in the control group (37.5% vs. 75%, P < 0.05). There were no significant differences in CT scores between the two groups (0.60 ± 0.88 vs. 1.00 ± 1.31, P = 0.917). Overall, the intravenous transplantation of hUC-MSCs accelerated partial pulmonary function recovery and improved HRQL, indicating relative safety and preliminary efficacy of this treatment for patients with severe COVID-19.


Subject(s)
COVID-19/therapy , Cord Blood Stem Cell Transplantation , Mesenchymal Stem Cell Transplantation , Adult , Aged , COVID-19/epidemiology , COVID-19/pathology , Case-Control Studies , China/epidemiology , Cohort Studies , Comorbidity , Cord Blood Stem Cell Transplantation/statistics & numerical data , Female , Follow-Up Studies , Humans , Male , Mesenchymal Stem Cell Transplantation/statistics & numerical data , Middle Aged , Patient Discharge , Respiratory Function Tests , SARS-CoV-2/physiology , Severity of Illness Index , Treatment Outcome , Umbilical Cord/cytology
3.
Regen Med ; 15(1): 1228-1237, 2020 01.
Article in English | MEDLINE | ID: mdl-32101099

ABSTRACT

Aim: This study examined how umbilical cord blood (UCB) use was portrayed in the English language North American popular press. Methods: Directed content analysis was conducted on 400 articles from 2007 to 2017 containing 'cord blood,' published by the most read Canadian and American news sources. Results: A total of 86.3% of the articles detailed UCB treatments and therapies, the majority of which align with clinical evidence. Some articles portrayed speculative/experimental therapies as efficacious. Public and private banking initiatives received substantial attention, and were portrayed diversely. Promotional narrative messaging was evident around private banking. Conclusion: Findings demonstrate the need for continual monitoring of the media portrayals of UCB as stem cell and transplantation research develops and as clinics continue to operate.


Subject(s)
Blood Banking/methods , Cord Blood Stem Cell Transplantation/trends , Fetal Blood/cytology , Blood Banks/standards , Blood Banks/statistics & numerical data , Canada , Cord Blood Stem Cell Transplantation/statistics & numerical data , Humans , United States
4.
Arch Med Res ; 51(1): 54-62, 2020 01.
Article in English | MEDLINE | ID: mdl-32086109

ABSTRACT

BACKGROUND: The umbilical cord blood bank at the Mexican Institute of Social Security (IMSS-CBB) was established in January 2005. This lead to the development of the UCB transplantation program. Herein, we describe the experience generated during these 13 years. STUDY DESIGN AND METHODS: Donor selection, as well as UCB collection, processing, and banking were performed under good manufacturing practices and standard operating procedures. UCB units were thawed, processed, and released for transplantation based on HLA and nucleated cell content. RESULTS: From January 2005-December 2017, 1,298 UCB units were banked; 164 of them were released for transplantation, and 118 UCB transplants were performed. Ninety-four transplants were performed in pediatric patients and 24 in adults. Sixty percent of them corresponded to patients with leukemia, 19% were patients with marrow failure, and the rest had immunodeficiency, hemoglobinopathy, metabolic disorders, or solid tumors. Engraftment was observed in 67 patients (57% of transplanted patients) and 64% of them were still alive when writing this article. In contrast, only 13 of the 51 (25%) non-engrafting patients were alive. At the time of writing this article, the disease-free survival rate was 37%, and the overall survival rate was 47%, with survival periods of 161-3,721 days. CONCLUSION: The IMSS UCB banking and transplantation program has had a significant impact for many IMSS patients. The hematopoietic transplantation program at our institution has benefited from the use of UCB as a source of transplantable cells.


Subject(s)
Blood Banking , Blood Banks , Cord Blood Stem Cell Transplantation , Fetal Blood , National Health Programs , Adolescent , Adult , Aged , Blood Banks/statistics & numerical data , Blood Banks/trends , Bone Marrow Failure Disorders/epidemiology , Bone Marrow Failure Disorders/therapy , Child , Child, Preschool , Cord Blood Stem Cell Transplantation/standards , Cord Blood Stem Cell Transplantation/statistics & numerical data , Cord Blood Stem Cell Transplantation/trends , Disease-Free Survival , Female , Hematopoietic Stem Cell Transplantation/standards , Hematopoietic Stem Cell Transplantation/statistics & numerical data , History, 21st Century , Humans , Infant , Infant, Newborn , Leukemia/epidemiology , Leukemia/therapy , Male , Mexico/epidemiology , Middle Aged , National Health Programs/organization & administration , National Health Programs/standards , National Health Programs/trends , Pregnancy , Retrospective Studies , Survival Rate , Young Adult , Blood Banking/methods
5.
Cytotherapy ; 21(11): 1112-1121, 2019 11.
Article in English | MEDLINE | ID: mdl-31587876

ABSTRACT

Clinical use of umbilical cord blood (UCB) for novel indications in regenerative therapy continues to rise, however, whether new indications are proven is less clear. An updated systematic search of the literature, focusing only on controlled clinical studies, is needed to properly assess potential efficacy. After updating our systematic search to April 1, 2018 (PROSPERO protocol CRD42016040157), a total of 16 studies were identified that addressed the treatment of cerebral palsy (four studies), type 1 diabetes (three studies), and nine other novel potential indications where only a single controlled study was identified. In the four controlled studies of patients with cerebral palsy, three used allogeneic cells and reported greater improvement in motor-related scores at 1, 3 and 6 months compared with controls. The results were mixed for other scores at other time points, including additional measures of mental and motor function. One study of autologous UCB treatment reported an improvement in motor function scores at 12 months compared with controls. In the three controlled studies of type 1 diabetes, two studies used autologous cells whereas one used allogeneic cord blood cells to "educate" autologous lymphocytes. Taken together, there was no clear difference in HbA1c levels or daily insulin requirements between treated patients and controls. For the nine published reports with a single controlled study, eight used allogeneic UCB cells and seven infused mesenchymal stromal cells derived from UCB. All but one study reported benefit. Many other published reports that lack a control group were not included in our analysis. More controlled studies are needed that use similar approaches regarding cell source and outcome measures at similar time points. Pooled estimates of results from multiple studies will be essential as published studies remain modest in size. Patients should continue to be enrolled in clinical trials because there are no novel potential indications remain unproven.


Subject(s)
Controlled Clinical Trials as Topic/statistics & numerical data , Cord Blood Stem Cell Transplantation , Fetal Blood/physiology , Regenerative Medicine , Cerebral Palsy/therapy , Controlled Clinical Trials as Topic/standards , Cord Blood Stem Cell Transplantation/methods , Cord Blood Stem Cell Transplantation/standards , Cord Blood Stem Cell Transplantation/statistics & numerical data , Diabetes Mellitus, Type 1/therapy , Fetal Blood/cytology , Humans , Infant, Newborn , Mesenchymal Stem Cells , Regenerative Medicine/methods , Regenerative Medicine/statistics & numerical data , Regenerative Medicine/trends
6.
BMC Infect Dis ; 18(1): 654, 2018 Dec 13.
Article in English | MEDLINE | ID: mdl-30545330

ABSTRACT

BACKGROUND: Bloodstream infection (BSI) is one of the major causes of morbidity and mortality for patients undergoing hematopoietic stem cell transplantation (HSCT). The unrelated cord blood transplantation (UCBT) can provided opportunities for patients without suitable donors for bone marrow transplantation (BMT) and peripheral blood stem cell transplantation (PBSCT), while few studies have addressed BSI after UCBT. The aim of this study was to analyse the incidence and risk factors of BSI, causative organisms, microbial resistance, and its impact on the clinical outcomes and survival of patients. METHODS: There are 336 patients, were divided into two groups depending on whether developing BSI. Demographic characteristics, laboratory data, and clinical outcome were compared between different groups. The risk factors of BSI was examined using logistic regression and the survival was examined using the Kaplan-Meier method and log-rank test. RESULTS: Ninety-two patients (27.4%) developed early BSI with 101 pathogenic bacteria isolated, and the median day of developing initial BSI was 4.5 d. Gram-negative bacteria were the most common isolate (60, 59.4%), followed by Gram-positive bacteria (40, 39.6%) and fungi (1, 1.0%). Thirty-seven (36.6%) isolates were documented as having multiple drug resistance (MDR). Myeloid malignancies, conditioning regimens including total body irradiation (TBI), and prolonged neutropenia were identified as the independent risk factors for early BSI. The 3-year OS was 59.9% versus 69.2% in the BSI group and no-BSI group (P = 0.0574), respectively. The 3-year OS of the MDR group was significantly lower than that of the non-BSI group (51.1% versus 69.2%, p = 0.013). CONCLUSIONS: Our data indicate that the incidence of early BSI after UCBT was high, especially in patients with myeloid disease and a conditioning regimen including TBI and prolonged neutropenia. Early BSI with MDR after UCBT had a negative impact on long-term survival.


Subject(s)
Bacteremia/epidemiology , Cord Blood Stem Cell Transplantation/adverse effects , Hematologic Neoplasms/epidemiology , Hematologic Neoplasms/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Bacteremia/etiology , Bacteremia/microbiology , Child , Cord Blood Stem Cell Transplantation/statistics & numerical data , Female , Hematologic Neoplasms/diagnosis , Hematologic Neoplasms/mortality , Hematopoietic Stem Cell Transplantation/adverse effects , Hematopoietic Stem Cell Transplantation/statistics & numerical data , Humans , Incidence , Male , Middle Aged , Peripheral Blood Stem Cell Transplantation/adverse effects , Peripheral Blood Stem Cell Transplantation/statistics & numerical data , Prognosis , Retrospective Studies , Risk Factors , Survival Analysis , Treatment Outcome , Unrelated Donors/statistics & numerical data , Young Adult
7.
J Pediatr Hematol Oncol ; 39(1): 33-37, 2017 01.
Article in English | MEDLINE | ID: mdl-27906795

ABSTRACT

Medical records of 82 patients with acute lymphoblastic leukemia (ALL) who underwent hematopoietic cell transplantation (HCT) at our institution from 2005 to 2011 were reviewed. Forty-five patients were male (54.8%). The median age at HCT was 7.46 years (range, 0.98 to 14.31 y), the median time to HCT after diagnosis was 12.56 months. Ten patients were below the age of 1 year (12%). All patients were in complete remission at the time of HCT. In 83 transplants, 64 patients received HCT from human leukocyte antigen-identical-related donors and 19 from other donors. Stem cell source was bone marrow in 65 (78%) and cord blood in 18 (22%). Five-year overall survival was 58.8% and event-free survival was 54.3%. The cumulative incidence of acute graft versus host disease was 4.8%±2.3% and of chronic graft versus host disease was 8.9%±3.2%. The median time to absolute neutrophil count and platelet recovery was 17 days (range, 12 to 43 d) and 28 days (range, 15 to 98 d), respectively. One patient acquired CMV infection after transplant. No one developed venoocclusive disease, hemorrhagic cystitis, or other complication. Patient's age at diagnosis, sex, donor's human leukocyte antigen status and sex, source of transplant and complete remission status at HCT did not affect overall survival and event-free survival. Our results show a favorable outcome to HCT for acute lymphoblastic leukemia patients comparable to published data, and no single factor was associated with superior outcome.


Subject(s)
Bone Marrow Transplantation/statistics & numerical data , Cord Blood Stem Cell Transplantation/statistics & numerical data , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Adolescent , Child , Child, Preschool , Combined Modality Therapy , Disease-Free Survival , Female , Graft vs Host Disease/epidemiology , Graft vs Host Disease/etiology , Humans , Infant , Kaplan-Meier Estimate , Male , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/epidemiology , Remission Induction , Retrospective Studies , Risk Factors , Saudi Arabia/epidemiology , Tertiary Care Centers/statistics & numerical data , Tissue Donors , Treatment Outcome
8.
Matern Child Health J ; 21(1): 208-214, 2017 01.
Article in English | MEDLINE | ID: mdl-27531008

ABSTRACT

Introduction Little is known about the prevalence of conditions potentially amenable to cellular therapy among families storing umbilical cord blood in private cord blood banks. Methods A cross-sectional study of families with at least one child who stored umbilical cord blood in the largest private cord blood bank in the United States was performed. Respondent families completed a questionnaire to determine whether children with stored cord blood or a first-degree relative had one or more of 16 conditions amenable primarily to allogeneic stem cell transplant ("transplant indications") or 16 conditions under investigation for autologous stem cell infusion ("regenerative indications"), regardless of whether they received a transplant or infusion. Results 94,803 families responded, representing 33.3 % of those surveyed. Of respondent families, 16.01 % indicated at least one specified condition. 1.64 % reported at least one first-degree member with a transplant indication potentially treatable with an allogeneic stem cell transplant. The most common transplant indications reported among first-degree family members were Non-Hodgkin's Lymphoma (0.33 %), Hodgkin's Lymphoma (0.30 %), and Acute Lymphoblastic Leukemia (0.28 %). 4.23 % reported at least one child with a regenerative indication potentially treatable with an autologous stem cell infusion. The most common regenerative indications among children with stored umbilical cord blood were Autism/Autism Spectrum Disorder/Apraxia (1.93 %), Other Developmental Delay (1.36 %), and Congenital Heart Defect (0.87 %). Discussion Among families storing umbilical cord blood in private cord blood banks, conditions for which stem cell transplant or infusion may be indicated, or are under investigation, appear to be prevalent, especially for regenerative medicine indications.


Subject(s)
Cord Blood Stem Cell Transplantation/methods , Fetal Blood/cytology , Prevalence , Anemia/genetics , Anemia/therapy , Cord Blood Stem Cell Transplantation/statistics & numerical data , Cross-Sectional Studies , Humans , Leukemia/genetics , Leukemia/therapy , Lymphoma/genetics , Lymphoma/therapy , Materials Management, Hospital/methods , Materials Management, Hospital/statistics & numerical data , Regenerative Medicine/methods , Regenerative Medicine/statistics & numerical data , Sarcoma/genetics , Sarcoma/therapy , Surveys and Questionnaires , United States
9.
Rinsho Ketsueki ; 57(5): 531-6, 2016 05.
Article in Japanese | MEDLINE | ID: mdl-27263776

ABSTRACT

Cord blood transplantation (CBT) has increasingly been used in Japan and the annual number of CBT now exceeds 1,200. The cumulative number of CBT reached 12,853 in 2015, accounting for almost 1/3 of total CBT performed worldwide. It is true that smaller body size and lower costs, as compared to western countries, have been advantages for Japanese people in using CB as graft alternative. In addition, several novel findings regarding serious issues following CBT have been obtained, which further enhanced the use of CB. First, several mechanisms of engraftment failure following CBT other than cell dose have been reported, such as the presence of donor-specific anti-HLA antibodies or the development of hemophagocytic syndrome. Second, unique profiles of infectious complications following CBT have been reported, such as higher incidences of early bacterial infections and HHV-6 encephalitis, as compared to those following bone marrow (BM)/peripheral blood (PB) transplants. Third, the incidence of disease relapse was comparable to those following BM/PB transplants. Novel pre-transplant conditioning regimens using intravenous busulfan have been investigated with promising results being obtained to date. A recent analysis of Japanese transplant registry data revealed similar survival following CBT to HLA-matched unrelated BM/PB transplants.


Subject(s)
Cord Blood Stem Cell Transplantation , Cord Blood Stem Cell Transplantation/adverse effects , Cord Blood Stem Cell Transplantation/statistics & numerical data , Fetal Blood , Humans , Japan , Recurrence , Treatment Outcome
10.
Am J Hematol ; 91(5): E284-92, 2016 May.
Article in English | MEDLINE | ID: mdl-26910296

ABSTRACT

Older recipient and donor age were associated with higher incidences of severe graft-versus-host disease (GVHD) and mortality after allogeneic hematopoietic stem cell transplantation from matched sibling donors (MSDs) and matched unrelated donors. Since a lower incidence of severe GVHD is advantageous in unrelated cord blood transplantation (CBT), a higher incidence of GVHD using older MSDs could be overcome using cord blood for older patients. We retrospectively analyzed Japanese registration data of 2,091 patients with acute myeloid leukemia, acute lymphoblastic leukemia (ALL), and myelodysplastic syndrome aged 50 years or older who underwent MSD bone marrow transplantation (BMT) (n = 319), MSD peripheral blood stem cell transplantation (PBSCT) (n = 462), or unrelated CBT (n = 1,310) between 2007 and 2012. Median age of MSD was 56 (range, 38-74) years. Compared with CBT, the risk of developing extensive chronic GVHD was higher after BMT (hazard ratio [HR], 2.00; P = 0.001) or PBSCT (HR, 2.38; P < 0.001), and transplant-related mortality was lower after BMT (HR, 0.61; P < 0.001) or PBSCT (HR, 0.63; P < 0.001). Relapse rates were not significant difference between three groups. Although overall mortality was lower after BMT (HR, 0.67; P < 0.001) or PBSCT (HR, 0.75; P = 0.002) compared with CBT, the rates of a composite endpoint of GVHD-free, relapse-free survival (GRFS) were not significant difference between three groups. These data showed that MSDs remain the best donor source for older patients, but CBT led to similar GRFS to BMT and PBSCT.


Subject(s)
Bone Marrow Transplantation/statistics & numerical data , Cord Blood Stem Cell Transplantation/statistics & numerical data , Living Donors , Peripheral Blood Stem Cell Transplantation/statistics & numerical data , ABO Blood-Group System/genetics , Age Factors , Aged , Blood Platelets , Bone Marrow Transplantation/adverse effects , Bone Marrow Transplantation/mortality , Cause of Death , Cord Blood Stem Cell Transplantation/adverse effects , Cord Blood Stem Cell Transplantation/mortality , Female , Graft Survival , Graft vs Host Disease/epidemiology , Graft vs Host Disease/etiology , HLA Antigens/genetics , Histocompatibility , Humans , Incidence , Japan/epidemiology , Leukemia, Myeloid, Acute/mortality , Leukemia, Myeloid, Acute/therapy , Male , Middle Aged , Myelodysplastic Syndromes/mortality , Myelodysplastic Syndromes/therapy , Neutrophils , Peripheral Blood Stem Cell Transplantation/adverse effects , Peripheral Blood Stem Cell Transplantation/mortality , Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Proportional Hazards Models , Recurrence , Severity of Illness Index , Siblings , Treatment Outcome
11.
Bone Marrow Transplant ; 51(6): 786-92, 2016 Jun.
Article in English | MEDLINE | ID: mdl-26901709

ABSTRACT

A record number of 40 829 hematopoietic stem cell transplantation (HSCT) in 36 469 patients (15 765 allogeneic (43%), 20 704 autologous (57%)) were reported by 656 centers in 47 countries to the 2014 survey. Trends include: continued growth in transplant activity, more so in Eastern European countries than in the west; a continued increase in the use of haploidentical family donors (by 25%) and slower growth for unrelated donor HSCT. The use of cord blood as a stem cell source has decreased again in 2014. Main indications for HSCT were leukemias: 11 853 (33%; 96% allogeneic); lymphoid neoplasias; 20 802 (57%; 11% allogeneic); solid tumors; 1458 (4%; 3% allogeneic) and non-malignant disorders; 2203 (6%; 88% allogeneic). Changes in transplant activity include more allogeneic HSCT for AML in CR1, myeloproliferative neoplasm (MPN) and aplastic anemia and decreasing use in CLL; and more autologous HSCT for plasma cell disorders and in particular for amyloidosis. In addition, data on numbers of teams doing alternative donor transplants, allogeneic after autologous HSCT, autologous cord blood transplants are presented.


Subject(s)
Hematopoietic Stem Cell Transplantation/statistics & numerical data , Surveys and Questionnaires , Amyloidosis/therapy , Anemia, Aplastic/therapy , Cord Blood Stem Cell Transplantation/statistics & numerical data , Europe , Hematopoietic Stem Cell Transplantation/methods , Hematopoietic Stem Cell Transplantation/trends , Humans , Neoplasms/therapy , Patient Care Team/statistics & numerical data , Patient Care Team/trends , Tissue Donors/statistics & numerical data , Transplantation, Autologous , Transplantation, Haploidentical , Transplantation, Homologous
13.
Indian J Pediatr ; 83(3): 238-41, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26590156

ABSTRACT

OBJECTIVES: To assess the knowledge of the general population and the medical specialists about the purpose and utility of cord blood banking. METHODS: One hundred individuals from the general population and 100 clinicians from various departments were enrolled in the study between August 2013 and November 2013. RESULTS: Fifty eight percent of the doctors and 82 % of the lay persons did not know any indication or were not aware of the correct indications of the use of cord blood for transplantation. Around half of the lay persons (42 %) and doctors (37 %) thought that umbilical cord blood can be used to treat any genetic disorder including Duchenne muscular dystrophy and mental retardation. Nineteen percent of the doctors thought that umbilical cord blood can be used to treat thalassemia in the same child. CONCLUSIONS: The propaganda done by cord blood banks that cord blood is a biological insurance for the child is misleading and should be discouraged. The obstetricians and the pediatricians should take a central role in providing the correct information to would be parents to help them in taking a correct decision.


Subject(s)
Blood Banks/statistics & numerical data , Cord Blood Stem Cell Transplantation/statistics & numerical data , Fetal Blood/transplantation , Health Knowledge, Attitudes, Practice , Adolescent , Adult , Humans , Physicians , Surveys and Questionnaires , Young Adult
14.
J Stem Cells ; 10(1): 33-41, 2015.
Article in English | MEDLINE | ID: mdl-26665936

ABSTRACT

In this study, a self-administered questionnaire was used to assess opinions about stem cell research and cord blood banking. Three attitudes were examined: willingness to accept cord blood banking, willingness to accept embryonic stem cell research, and religious belief system. A total of 90 Wayne State University students enrolled in the study in response to an invitation posted on a web page for the university. Sex distribution among study participants was 79 females and eight males; three declined to state their sex. Support for cord blood banking was high (> 70%) among students. Students over the age of 25 years of age were more (85%) positive than students 18 to 24 years old (57%). They prefered a public cord blood bank over a private cord blood bank. Atheist/agnostic or spiritual/not religious students (> 90%), Catholic students (78%) and Christian students (58%) support cord blood banking. Age, sex and religion seems influence the student's attitude towards stem cell research and cord blood banking.


Subject(s)
Blood Banks/ethics , Cord Blood Stem Cell Transplantation/ethics , Fetal Blood/cytology , Public Opinion , Stem Cell Research/ethics , Students/psychology , Adolescent , Adult , Age Factors , Attitude to Health , Blood Banks/statistics & numerical data , Cord Blood Stem Cell Transplantation/statistics & numerical data , Female , Fetal Blood/physiology , Humans , Male , Religion , Sex Factors , Surveys and Questionnaires
15.
Life Sci Soc Policy ; 11: 11, 2015.
Article in English | MEDLINE | ID: mdl-26449725

ABSTRACT

Umbilical cord blood (UCB) has become the focus of intense efforts to collect, screen and bank haematopoietic stem cells (HSCs) in hundreds of repositories around the world. UCB banking has developed through a broad spectrum of overlapping banking practices, sectors and institutional forms. Superficially at least, these sectors have been widely distinguished in bioethical and policy literature between notions of the 'public' and the 'private', the commons and the market respectively. Our purpose in this paper is to reflect more critically on these distinctions and to articulate the complex practical and hybrid nature of cord blood as a 'bio-object' that straddles binary conceptions of the blood economies. The paper draws upon Roberto Esposito's reflections on biopolitics and his attempt to transcend the dualistic polarisations of immunity and community, or the private and the public. We suggest that his thoughts on immunitary hospitality resonate with many of the actual features and realpolitik of a necessarily internationalised and globally distributed UCB 'immunitary regime'.


Subject(s)
Blood Banks , Cord Blood Stem Cell Transplantation , Hematopoietic Stem Cells , Stem Cell Research/ethics , Blood Banks/statistics & numerical data , Blood Donors , Cord Blood Stem Cell Transplantation/statistics & numerical data , Fetal Blood , Global Health , Hematopoietic Stem Cells/immunology , Humans , Informed Consent , International Cooperation , Policy Making , Politics , Private Sector , Public Sector
16.
Rev Med Inst Mex Seguro Soc ; 53 Suppl 1: S94-9, 2015.
Article in Spanish | MEDLINE | ID: mdl-26020672

ABSTRACT

BACKGROUND: Hematopoietic stem cells have been used for over 50 years in the treatment of diverse diseases. Umbilical cord blood (UCB) has proved to be a viable source of hematopoietic stem cells for transplantation purposes. The aim was to report the contribution of the umbilical cord blood bank over the past 9 years, in the treatment of various diseases. METHODS: Since 2005 the number of units of blood from the umbilical cord and their use for transplantation in diverse disease were analyzed. A selection of volunteer pregnant women in labor was performed. Umbilical cord blood was obtained from them, which underwent processing, cryopreservation and validation, as well as compatibility test before using for transplantation. RESULTS: Ten thousand and ninety nine candidates to donation were assessed, from whom 2481 unit of UCB were collected. Of these, 893 unit were processed and cryopreserved for transplantation. In 65% of cases there was histocompatibility between the cord cell and the receptors. Transplantation was done in 87 patients, 67% had hematologic neoplasias, who have received 140 units of UCB in 102 transplants. This Bank of UCB ranks second in the world in productivity according to the rate of utility of units in transplantation (3.3%). CONCLUSIONS: Our bank of UCB has been able to develop a cell line (hematopoietic stem cells) with international quality standards and has been beneficial for patients served by our institution with need of a transplant mainly in hemato-oncologic patients.


Introducción: las células troncales hematopoyéticas se han empleado por más de 50 años en el tratamiento de diversas enfermedades. La sangre de cordón umbilical es una fuente viable de células troncales hematopoyéticas con fines de trasplante. El objetivo es informar la aportación clínica del banco de células de cordón umbilical (BCCU) en el tratamiento de diversas enfermedades.Métodos: desde 2005 a la fecha se analizó el número de unidades de sangre de cordón umbilical (SCU) y su empleo para el trasplante en diversas enfermedades. Se seleccionaron donadoras embarazadas voluntarias en trabajo de parto de quienes se recolectó SCU, la cual fue sometida a su procesamiento, criopreservación y validación, así como a estudios de compatibilidad previo a su uso para trasplante.Resultados: se evaluaron 10 099 candidatas a donación, de quienes se recolectaron 2481 unidades de SCU, de estas se procesaron y criopreservaron 893 unidades para trasplante. En 65 % de los casos hubo histocompatibilidad entre las células de cordón y el receptor. Se trasplantaron 87 pacientes (67 % neoplasias hematológicas), que recibieron 140 unidades SCU en 102 trasplantes.Conclusiones: nuestro Banco de CCU ha logrado desarrollar una línea celular (troncales hematopoyéticas) con estándares de calidad internacionales, y ha beneficiado a pacientes con necesidad de un trasplante, en especial los padecimientos oncohematológicos.


Subject(s)
Blood Banks/statistics & numerical data , Blood Donors/statistics & numerical data , Cord Blood Stem Cell Transplantation/statistics & numerical data , Donor Selection/statistics & numerical data , Fetal Blood/transplantation , Academies and Institutes , Adolescent , Adult , Blood Donors/supply & distribution , Donor Selection/methods , Female , Humans , Infant, Newborn , Mexico , Pregnancy , Social Security , Young Adult
18.
Biol Blood Marrow Transplant ; 21(7): 1188-94, 2015 Jul.
Article in English | MEDLINE | ID: mdl-25687797

ABSTRACT

Umbilical cord blood transplants are now used to treat numerous types of immune- and blood-related disorders and genetic diseases. Cord blood (CB) banks play an important role in these transplants by processing and storing CB units. In addition to their therapeutic potential, these banks raise ethical and regulatory questions, especially in emerging markets in the Arab world. In this article, the authors review CB banking in five countries in the region, Jordan, Saudi Arabia, Egypt, Qatar, and the United Arab Emirates, selected for their different CB banking policies and initiatives. In assessing these case studies, the authors present regional trends and issues, including religious perspectives, policies, and demographic risk factors. This research suggests strong incentives for increasing the number of CB units that are collected from and available to Arab populations. In addition, the deficit in knowledge concerning public opinion and awareness in the region should be addressed to ensure educated decision-making.


Subject(s)
Arab World , Blood Banks/ethics , Cord Blood Stem Cell Transplantation/trends , Hematopoietic Stem Cell Transplantation/trends , Blood Banks/economics , Blood Banks/trends , Cord Blood Stem Cell Transplantation/ethics , Cord Blood Stem Cell Transplantation/ethnology , Cord Blood Stem Cell Transplantation/statistics & numerical data , Fetal Blood/cytology , Fetal Blood/physiology , Health Knowledge, Attitudes, Practice/ethnology , Hematopoietic Stem Cell Transplantation/ethics , Hematopoietic Stem Cell Transplantation/ethnology , Hematopoietic Stem Cell Transplantation/statistics & numerical data , Humans , Risk Factors
19.
Ann Hematol ; 94(3): 481-9, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25417830

ABSTRACT

To gain insight into the natural history of cytomegalovirus (CMV) infection following unrelated cord blood transplantation (UCBT) in seropositive patients, we analyzed the data of 349 seropositive patients who received UCBT in Korea between 2000 and 2011. CMV reactivation occurred in 49 % (171/349) of the CMV-seropositive transplant recipients at a median of 31 days post UCBT. One hundred sixty-four out of 171 patients (96 %) received preemptive therapy. The median duration of CMV reactivation was 29 days. In multivariate analysis, weight >22 kg, use of total body irradiation, use of pre-transplant antithymocyte globulin, graft-versus-host disease (GVHD) prophylaxis with mycophenolate mofetil, and presence of grade II-IV acute GVHD were independent predictors of CMV reactivation. CMV reactivation did not impact transplantation-related mortality (TRM), leukemia relapse, or survival. CMV disease was diagnosed in 62 patients (17.8 %) at a median 55 days after UCBT. Longer duration of CMV reactivation was the only risk factor for progression to CMV disease (p = 0.01). CMV disease resulted in higher TRM (56.0 vs. 31.4 %, p < 0.01) and lower survival (36.1 vs. 55.1 %, p = 0.02).


Subject(s)
Cord Blood Stem Cell Transplantation , Cytomegalovirus Infections/epidemiology , Leukemia/epidemiology , Leukemia/therapy , Transplant Recipients/statistics & numerical data , Unrelated Donors , Adolescent , Adult , Aged , Child , Child, Preschool , Cord Blood Stem Cell Transplantation/statistics & numerical data , Cytomegalovirus/immunology , Cytomegalovirus/physiology , Cytomegalovirus Infections/complications , Female , Humans , Infant , Leukemia/complications , Leukemia/immunology , Male , Middle Aged , Republic of Korea/epidemiology , Seroepidemiologic Studies , Transplantation, Homologous , Virus Activation , Young Adult
20.
Biol Blood Marrow Transplant ; 21(1): 50-4, 2015 Jan.
Article in English | MEDLINE | ID: mdl-25262882

ABSTRACT

Umbilical cord blood (UCB) may be collected and cryopreserved for years before use. In vitro and murine models suggest that the duration of storage does not affect UCB progenitor cell performance; however, the impact of UCB age on clinical outcomes has not been definitely defined. This study sought to determine the effect of UCB unit cryopreservation time on hematopoietic potency. We analyzed 288 single UCB units used for transplantation from 1992 to 2013, with unit cryopreservation time ranging from .08 to 11.07 years. UCB unit post-thaw characteristics were examined, including percent recovery of total nucleated cells (TNC). The number of years the UCB unit spent in cryopreservation had no impact on TNC recovery nor UCB unit post-thaw viability. Duration of cryopreservation also had no impact on neutrophil or platelet engraftment in single UCB transplantations. These results show that UCB units can undergo cryopreservation for at least 10 years with no impact on clinical outcomes.


Subject(s)
Cord Blood Stem Cell Transplantation/methods , Cryopreservation/methods , Fetal Blood/cytology , Graft Survival , Blood Platelets/cytology , Blood Platelets/physiology , Cell Count , Cell Survival , Cord Blood Stem Cell Transplantation/statistics & numerical data , Fetal Blood/physiology , Humans , Neutrophils/cytology , Neutrophils/physiology , Retrospective Studies , Time Factors
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