Umbilical Cord Blood Transplantation: Challenges and Future Directions

Abstract

Summary Since the first successful allogeneic transplants performed in Seattle 50 years ago, the field of transplantation has evolved considerably, with improvements in human leukocyte antigen typing, patient selection, reduced intensity regimens, and graft-versus-host disease prophylaxis. A major breakthrough has been the availability of more donor options, first via the National Marrow Donor Program—Be the Match [Biol Blood Marrow Transplant 2008;14:2–7]. Then, in the 1990s, unrelated umbilical cord blood transplantation became available, first for children and then for adults [New Engl J Med 1996;35:157–166]. More recently mismatched unrelated transplants and haploidentical donor options became available [Blood 2011;118:282–288]. In 2017, there is a donor for almost every patient who needs a transplant. In this review, we will discuss the state of the science (and art) of cord blood transplant, focusing on successes, challenges, and future directions.