Collection and Transplantation of Related UCB. 10 Years Experience of the Pavia CB Bank.

Besides large-scale banking of unrelated units, CB banks (CBBs) collect and store dedicated cord blood (CB) for sibling patients. In this setting the recipient is already designated, therefore special care is applied to all critical steps of CB management, from collection to infusion, to ensure the highest quality of the graft and the successful outcome of transplant. CB collection procedures must also protect mother and infant donors. According to FACT Netcord standards, delivery practice cannot be modified in attempt to increase CB volume. In case of in utero collection, additional safeguards are requested and in multiple gestation pregnancies, all infants shall be delivered before any CB collection begins. The mother must sign a written informed consent and CB can be drawn from infants after at least 34 week gestation. Moreover, the CBB shall maintain all details of clinical outcome for related allotramsplants. In particular, data on adverse events associated with the infusion of CB shall be carefully recorded. We report our experience of banking CB for sibling recipients to be transplanted at the onchohematologic-paediatric division of our hospital. From 1996 we have collected and banked 104 dedicated CBs (64 for hematological and 40 for inherited disorders). Collections were carried out mostly in the obstetric ward of our hospital (77%); 40 (39%) and 64 (61%) units by vaginal and caesarean delivery, respectively. Eligibility to caesarean delivery was strictly dictated by obstetric factors and never due to CB collection requirements. Mean maternal age was 32 years (18–42). Infant donors were 61 (59%) males and 43 (41%) females; mean neonatal weight was 3178 g (1270–4720) and gestation week 38 (35–41). 6/104 (5.7%) collections were obtained during twin pregnancies. No adverse reaction on both newborn and mother was reported by the obstetric or neonatology staff. The characteristics of CB donations at collection were: volume 102 ml (25–199), nucleated cells (NC) 924 ×10⁶ (59.6–2193), CD34+ cells 269 ×10⁴ (8.9–1226.4), viability 96.5 % (54.7–99.9), CFU-GM 343.1 ×10⁴ (8.5–2112.5). Bacterial contamination occurred in 2 cases (1.9%). Prenatal HLA typing was available for only 21/104 (20%) donors and most of the units were typed after collection. 39/104 units (37%) matched their recipient and 28/104 (27%) were successfully transplanted. The characteristics of CBs at infusion were: collected NC dose 6.3 ×10⁷ (1.8–15.6), infused NC dose 4.6 ×10⁷ (1.4–14) and collected CD34+ cells dose 1.9 ×10⁶ (0.3–10.5), all shown per kg recipient weight. The outcome data were available for 24/28 (86%) CBs, in particular no adverse event associated to CB infusion or DMSO toxicity was reported. Preserving the uniqueness of the graft for sibling transplantation imposes a rigorous organizational network to prevent any technical or organisational setback. In our hands, this strategy was effective in ensuring the best quality and safety of the stem cell product guaranteeing at the meantime the protection of mother and infant donors.