Ethnic diversity and cord blood banking: satisfying the unmet need |
| |
| Affiliation: | 1. Instituto de Investigación Sanitario Fundación Jiménez Díaz, Madrid, Spain;2. Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain;1. HSC Processing and Cell Therapy Unit, Blood and Tissue Bank of Cantabria, Marqués de Valdecilla Foundation, Hospital de la Santa Cruz de Liencres, Liencres Cantabria, Spain;2. Haematologic Neoplasms and Haematopoietic Stem Cells Transplantation Group, Marqués de Valdecilla Research Institute, Santander, Spain;1. Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center, Tampa, Florida, USA;2. Department of Pathology and Laboratory Medicine, Phoenix Children''s Hospital, Phoenix, Arizona, USA;3. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA;4. Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri, USA;5. Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA;6. Department of Pathology and Laboratory Medicine, University of Miami, Miami, Florida, USA;7. Department of Pathology, Molecular and Cell-Based Medicine, Mount Sinai Health System, Icahn School of Medicine, New York, New York, USA;8. Laboratory Medicine and Pathology and Center for Regenerative Medicine, Mayo Clinic, Jacksonville, Florida, USA;9. Department of Pediatric Hematology/Oncology/Neuro-Oncology/Stem Cell Transplant, Ann & Robert H. Lurie Children''s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA;10. Division of Transfusion Medicine and Cellular Therapy, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA;11. Department of Clinical Hematology and Bone Marrow Transplant, Tata Medical Center, Kolkata, India;12. Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;1. Medical Affairs and Innovation, Héma-Québec, Québec City, Canada;2. Cord Blood Bank, Héma-Québec, Montréal, Canada;3. Centre for Innovation, Canadian Blood Services, Ottawa, Canada;4. Biochemistry, Microbiology and Immunology Department, University of Ottawa, Ottawa, Canada;1. Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Canada;2. Schulich School of Medicine, Western University, London, Canada;3. Faculty of Medicine, University of Ottawa, Ottawa, Canada;4. Department of Surgery, University of Ottawa, Ottawa, Canada;5. Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada |
| |
| Abstract: | Background aimsIn this study, the authors sought to assess whether cord blood units (CBUs) collected from donors of non-European ethnic backgrounds are utilized for umbilical cord blood transplantation (UCBT) at a different rate than those of European ethnic backgrounds. The authors also examined potential methods of enriching these under-represented ethnic backgrounds in cord blood bank (CBB) inventories without increasing financial overheads and without compromising total inventory utilization or post-transplant outcomes.MethodsData from N = 6506 searchable or shipped Anthony Nolan Cell Therapy Centre grafts were used in this study. Banked grafts were graded from A+ to D based on total nucleated cell and CD34+ cell content. Utilizations of each grade group were further stratified by graft ethnic background. The Mantel–Cox log-rank test was performed in conjunction with Kaplan–Meier survival analysis to compare utilization rates and post-transplant outcomes. For shipped grafts, levels of HLA matching at HLA-A, HLA-B and HLA-DR loci were also analyzed by graft ethnic background and grade using data from the Eurocord/EBMT registry.ResultsOverall utilization of non-European grafts did not significantly differ from that of European grafts (2.5% versus 2.2%, P = 0.23). However, significant differences were found when stratifying utilization rates by cell content. The probability of non-European D grade grafts being utilized was 3-fold higher than that of European D grade grafts (1.1% versus 0.4%, P = 0.03) and comparable to that of European C grade grafts (1.1% versus 0.9%, P = 0.90). No significant differences were found between D and C grade grafts in terms of overall survival (OS) (P = 0.12), in part due to a disproportionate utilization of D grade grafts for pediatric UCBT (74% versus 39%, age difference P < 0.001). Furthermore, non-European graft shipments were 4-fold less likely to be a 6/6 HLA match to their recipients relative to European graft shipments (7% versus 29%).ConclusionsThe authors have identified a niche for CBUs of low cell content collected from donors of non-European ethnic backgrounds that has been overlooked by previous studies. Banking of these CBUs for pediatric UCBT instead of CBUs from European donors containing modestly higher cell content is an ethical approach to increasing the ethnic diversity of CBB inventory—and, consequently, the probability of non-European recipients finding a 6/6 HLA-matched graft—without compromising post-transplant OS or overall rate of inventory utilization. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
