Abstract
Abstract 4195
Directed family cord blood (DCB) storage provides hemopoietic stem cell source for transplantation (HSCT) for families with an existing or a potentially future recipient with HSCT curable disease (D). The National CB Banks Network in Italy (ITCBN) has a leading role in providing public DCB service for high-risk families, in compliance to GITMO directives for eligibility criteria (HSCT curable D: malignant MD, non MD, inherited ID). To provide best cost-effective practices recommendations it is important to report on DCB procedures and HSCT rate (HSCT-R) among public Banks. By 12.12.2008 almost 1800 DCB units were stored in 18 Italian Banks and 104 (9%) issued for HSCT. The present survey aims at summarizing the over 15 yrs DCB experience among 5 ITCBN Banks active since 1997 (range 1990-1997), and including 670 DCB units.
Preliminary analysis reports a 94% overall compliance to eligibility criteria directives, and overall HSCT- R for an alive sibling of 12% (63/522); the 63 HSCT were 97% matched, for curing ID in 84% and with 72 % overall survival outcome. Different policies among Banks were compared (Bank vs others: 1) eligibility criteria distribution : Bank PV06 DCB for MD <50% (42% vs 55-67%), Banks Rm04,R04 significant DCB for non sibling recipient (parent with MD) (17-24% vs 0.5%-2%), Bank T02 with significant (53/261) DCB for future sibling with ID (20% vs 2-5%); 2) Timing of HLA typing: Banks T02,FI03,PV06 with DCB following prenatal HLA (20-27% vs 0%), Banks FI03,Rm04,PV06 with CB HLA typed at birth (61-73% vs 23-25%). Significant HSCT-R (37/177=21 %) was reported by PV06 (HLA selection based storage). Lowest HSCT-R by Rm04,R04 (3/101=3%-5/98=5%) (parental mismatch). At T02 when excluding DCB for future sibling (low birth rate), and autologous (11 ID) HSCT-R increased from 6% (15/261) to 9% (15/170)
Advice for public long-term DCB storage should depend on HLA compatibility, potential recipient, disease progression, and likelihood/ timing of using DCB; Italian CB Banks are actively cohoperating to find best public banking practices to ensure a CDB storage system that is ethical, cost effective and responsive to patient needs.
No relevant conflicts of interest to declare.
Author notes
Asterisk with author names denotes non-ASH members.
