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The main mechanisms of action resulting in a long-term cure, but also in many life-threatening side effects after HSCT, are mediated by the rapidly reconstituting immune repertoire, which depends on the conditioning regimen, cell dose and graft composition, as well as the type of immune suppression. However, knowledge of these mechanisms is limited, due to many variations in clinical programs, including the specific type of transplantation procedure, as well as a lack of standardized immune monitoring after HSCT.

Umbilical cord blood (UCB) cells for allogeneic use are collected and frozen in more than 130 public CB banks worldwide. More than seven hundred and fifty thousands CB units (CBU) are available for transplantation. In this chapter we will describe some procedures for cord blood collection, processing, banking and recommendations on how to choose a single or double UCB unit for transplantation (Garcia ).

It is known that multiple factors impact on transplantation outcome; the heaviest ones are disease-related (disease refractoriness, phase, clonal abnormalities, etc. in malignancies and disease type and associated rejection risk in non-malignant diseases) and patient-related (age, comorbidities, infectious diseases/colonization, etc.). Moreover, donor-related issues and stem cell source may influence the extent of disease control and transplant-related mortality.

HSCT is a therapeutic procedure that can cure and/or prolong life in a broad range of hematologic disorders including malignant and nonmalignant pathologies. Conditioning is the preparative regimen that is administered to the patients undergoing HSCT before the infusion of the stem cell grafts.

Historically, the bone marrow (BM) has been the first source of stem cells considered since the early 1960s for HSCT (Santos ; Thomas et al. ; Mathe ; Gorin et al. ). Parallel attempts at using fetal liver cells at that time have remained unsuccessful. In 1986 the first success of an unrelated cord blood (UCB) transplantation in a child promoted UCB (Gluckman et al. ) as an alternative source in certain settings.

The intravenous infusion of patient’s own HSC to restore BM damage is the basic principle of high-dose chemotherapy, since otherwise the patient would expect long-lasting aplasia with life-threatening infections. Therefore, a sufficient collection of HSC before application of high-dose therapy is mandatory. Since HSC expresses CD34 on their surface, the number of CD34+ cells in the transplant material is considered as an indicator of the HSC content.

Collecting or harvesting HSCs from children is a challenge, not only because children have different physiological and therefore anatomical situations but also because psychological, legal and ethical concerns in minors are sometimes more difficult compared to adult donors. In addition, parents and/or legal guardians have to be addressed in all issues. This chapter will focus on the technical, physiological, and ethical problems in the field of HSC collection from children rather than indications.

The efficiency of an autologous, as well as an allogeneic, HSCs graft is mainly determined by the number of CD34 cells present. The dose of transplanted CD34 cells per kg body weight (BW) determines the kinetics of the neutrophil and platelet engraftment after auto-HSCT (Weaver et al. ). The measurement of CD34 cells by flow cytometry is, therefore, an important method to assess the graft quantity.

Umbilical cord blood (UCB) cells for allogeneic use are collected and frozen in more than 130 public CB banks worldwide. More than seven hundred and fifty thousands CB units (CBU) are available for transplantation. In this chapter we will describe some procedures for cord blood collection, processing, banking and recommendations on how to choose a single or double UCB unit for transplantation (Garcia ).

Graft manipulation is performed to define and to optimize the volume and cellular composition of stem cell sources like apheresis products, bone marrow, or umbilical cord blood.