Unrelated Umbilical Cord Blood Transplantation and Immune Reconstitution
This review highlights the unique features of immune reconstitution following unrelated cord blood transplantation (UCBT) that lead to heightened risk of infection-related mortality in the early post-UCBT period. There is no evidence that innate immunity is uniquely compromised after UCBT, but the development of antigen-specific cellular immunity is affected by numerical and qualitative deficits, primarily within the first 100 days. Nevertheless, beyond the first few months after UCBT there is no evidence for reduced graft-versus-leukemia (GVL) or anti-viral immunity compared to other hematopoietic cell therapy (HCT) modalities. Novel cellular therapies that are about to enter the clinical setting in the form of natural killer (NK) cell and T-cell therapies in the form of donor lymphocyte infusion (DLI) are also discussed.
aDepartment of Pediatrics, Division of Pediatric Bone Marrow Transplantation, Duke University Medical Center, Durham, NC
bDepartment of Immunology, Duke University Medical Center, Durham, NC
cDivision of Pediatric Blood and Marrow Transplantation, Morgan Stanley Children's Hospital, NewYork-Presbyterian, Columbia University, New York, NY
Address correspondence to Mitchell S. Cairo, MD, Division of Pediatric Blood and Marrow Transplantation, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital, Columbia University, 3959 Broadway, CHN 10-03, New York, NY 10032
M.S.C. was supported in part by grants from National Heart, Lung and Blood Institute (NIH N01-HB-67136), National Institute of Arthritis and Musculoskeletal and Skin Diseases (R21 AR49330), Pediatric Cancer Research Foundation, BevanMar Foundation, Marisa Fund, Sonia Scaramella Fund, Paul Luisi Foundation, and the Brittany Barron Fund. P.S. was supported in part by Grant No. R01-CA132110, The Childrens' Miracle Network, The National Marrow Donor Program-Marrow Transplant Research grant, and 1PO1-HL-67314-01A1 (Principal Investigator: N. Chao).
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