Cord blood banking Introduction-State of the art

Since the early years 1990 when the first cord blood (CB) banks were created, the worldwide inventory has grown considerably to a current 590 thousand units that complement the 22 M donors to provide hematopoietic progenitor cells (HPC) to patients in need of an allogeneic transplantation. The existing inventory shows a high degree of heterogeneity with a significant number of units below the current transplantation standards for adult patients. In the mean time, the use of CB as a HPC source has remained steady over the last years, leading to a relative decrease in the release activity in each individual bank.
New challenges and innovations have emerged, such as:
• More stringent regulations in the USA and in the EU
• Upgrades in professional standards
• Competing transplantation approaches such as easier access to adult unrelated donors (UD), use of haplo identical donors, single or multiple CB transplantation
• CB collection safety becoming a concern since issues have been raised about the outcome of newborns linked to their iron status
• The definition of clear criteria for transplant selection (HLA typing level, cell contents)
• Potential role of CB banks in non hematological CB use (use of CB byproducts, generation of iPS from selected universal donors, immunotherapy, HIV therapy)
• Financial restrictions
The elements mentioned above have lead banking strategies, including recruitment, donor selection, CB collection, processing, storage and release to evolve considerably and to incorporate
• Active volunteer accreditation processes for international recognition
• Donor recruitment: more detailed and selective donor evaluation
• Systematic nucleic acid (NAT) testing for infectious disease markers (IDM)
• Extensive use of molecular HLA typing and widening range of loci to be taken into account
• Evolving definition of acceptance criteria for incoming CB units, (i.e. stricter TNC requirements)
• Well standardized processing and storage methods
• Evaluation and adaptation of supply vs. needs in strategic approaches
• Need to increase and optimize CB visibility through up to date electronic solutions
• Methods to have a permanent and up to date overview of post transplantation outcomes, including elements relevant to the banking and clinical side
Professional organizations (NetCord, WMDA, FACT, WBMT) are in the process of tightening their links in order to increase interactions and respond in time to upcoming challenges and evolutions of the field.