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Comparison Between Bone Marrow or Peripheral Blood Stem Cells and Cord Blood Donated for Transplantation

Bone Marrow/Peripheral Blood Cord Blood
Bone marrow donation requires surgery under general anesthesia. Donors may experience temporary discomfort and/or pain. Long-term consequences of growth factors used in peripheral blood stem cell donations are uncertain. When obtained from the delivered placenta and umbilical cord, cord blood donation poses no medical risk to mother or infant

A transplant requires donation of a quart or more of bone marrow (mixed with blood).

A small volume (sometimes few ounces) can be used for transplantation. The number of cells needed depends on the recipient’s weight.
Bone marrow and peripheral blood grafts contain large numbers of stem cells. Engraftment of neutrophils is rapid. Cord blood units contain smaller numbers of stem cells. Slower engraftment may lead to prolonged hospital stay, and in certain cases, to serious complications.

After a formal search is started, it usually takes 2 or more months to transplant, if a donor is available.

When a match is found, it can take only a few days for confirmatory and special testing for shipment to the Transplant Center (less than 24 hours in an emergency).

Potential donors may no longer be available or may have withdrawn consent. Donor must be found and retested to confirm the HLA typing and infectious disease results and to confirm that the donor is still willing and able to donate bone marrow. Significant donor attrition. Once frozen, a cord blood unit is available until used. There is no donor attrition.

Donor may be available to give a second transplant or to donate blood for T-cells if necessary.

Donor is not available for a second donation
Bone marrow is used fresh (shelf-life measured in hours). Peripheral blood stem cells usually stored for short term (days to a few months). Cord blood units are cryopreserved (stored in special freezers). Frozen cord blood has been transplanted successfully after up to 13 years in storage.

Patient must begin conditioning before the bone marrow or peripheral bloods harvest. Coordination between donation and transplant is critical and complex.

Cord blood graft can be shipped to the transplant center before the patient enters the hospital and begins conditioning for transplantation. Coordination is simple. Cord blood units are shipped on demand.

Latent viral infection in the donor is common (i.e. CMV > 50% in U.S. adult donors). Latent viral infection in the cord blood donor is rare (i.e. CMV <1% in U.S.).

No risk of transplanting a genetic disease.

There is a small probability that a rare, unrecognized genetic disease affecting the blood or immune system of the baby may be given with the cord blood transplant.

Severe graft vs host disease (GvHD) is common with mismatched grafts. GvHD less frequent, usually less severe and easier to treat

Generally requires a perfect match between donor and recipient for 8/8 HLA-A, -B, -C and -DRB1 antigens. Additional HLA factors (HLA-DQ and -DP) increasingly used to improve prognosis.

HLA-mismatched cord blood transplants are possible, making it easier to find a suitable match. Role of HLA-C, -DQ and -DP are not yet known.

Cord blood transplants, as all unrelated hematopoietic stem cell transplants, can be associated with serious complications, severe organ toxicity, and in some cases, death.


 

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Cord blood is an investigational product not licensed by the FDA.