International Exchange of Cord Blood Units: the Registry Aspects

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WMDA WHITE PAPER International exchange of cord blood units: the registry aspects

K Welte1, L Foeken2, E Gluckman3 and C Navarrete4, on behalf of the Cord Blood Working Group of the World Marrow Donor Association

1National Marrow Donor Program, Minneapolis, MN, USA; 2Europdonor Foundation, WMDA, Leiden, The Netherlands; 3Department of Hematology, Hopital St Louis, Service de Greffe Moelle, Paris, France and 4NHS Blood and Transplant, London, UK

The international exchange of cord blood units (CBUs) several CBBs. As the World Marrow Donor Association for transplantation has brought new challenges to the (WMDA) documentation only covered the international stem cell donor registries involved in the exchange of BM exchange of BM and PBSC, the Cord Blood Working and PBSCs. The unique properties of cord blood cells and Group (CBWG) was initially established in 2007 to gather differences in the search processes between CBUs and and share information about a range of cord blood issues. adult unrelated donors has required registries responsible Thus, the early work of the CBWG involved surveys and for cord blood bank (CBB) networks to review their discussions to understand the current practices of registries current practices and to develop new processes to already involved in facilitating the international exchange accommodate for the provision of CBUs. This paper of cord blood units (CBUs). More recently, the work has describes the aims and activities of the World Marrow focused on the standardization of the CBU-associated Donor Association (WMDA) Cord Blood Working Group documentation and services provided by registries and (CBWG) which was established in 2007 to gather and CBBs, especially around the speciﬁc processes and proce- exchange information about cord blood registry needs and dures related to exchange of CBUs. This CBWG has also activities, and to develop guidelines to support and worked closely with Eurocord to provide some initial promote safe effective international exchange of unrelated recommendations for the search and selection of CBUs for CBUs for transplantation. transplantation. This paper provides information about the Bone Marrow Transplantation (2010) 45, 825–831; aims and activities of this recently established working doi:10.1038/bmt.2010.11; published online 1 March 2010 group and describes some of the most relevant operational Keywords: hematopoietic SCT; registry; cord blood and regulatory issues involved in the provision of CBUs.

CBBs and cord blood registries Introduction There are 131 voluntary CBBs established in 35 countries. These CBBs are variously run by hospitals, blood banks or Stem cell donor registries were founded when adult BM free-standing organizations. The main aim of a CBB is to donor volunteers were the only source of hematopoietic collect voluntarily donated cord blood to be used for any stem cells (HSCs) for unrelated transplantation. The patient who may need an unrelated hematopoietic SCT. procedures and systems used by the registries were designed The number of CBUs available for transplantation to conduct donor searches and facilitate the safe exchange increased 10 fold from 44 000 in 1999 to 452 000 in 2008 of adult BM and later PBSCs. Since the first successful (Figure 1) with an associated increase in the use of cord hematopoietic SCT using cord blood from a sibling in blood products from 3 in 1993 to 3529 in 2008 (Figure 2). 19881 and the establishment of the first public umbilical The main aspects of CBBs are to collect, process, test, cord blood banks (CBBs) in New York, USA2 and bank, select and release CBUs for transplantation. The Du¨sseldorf, Germany in the early 90s, cryopreserved cord majority of CBBs operate in close association with their blood cells became a third source of stem cells. Thirty-two national registry of volunteer adult donors and therefore stem cell donor registries have expanded their services and those aspects related to the listing, selection, issue and now also provide cord blood products. Some registries have transport of the CBUs are usually carried out by the collaboration with a single CBB; others have a network of registry. However, there are CBBs that operate indepen- dently and in those cases they need to establish their own procedures related to the registry activities. For example, Correspondence: K Welte, Center for Cord Blood, National Marrow when a CBU is released for registration in the international Donor Program, 3001 Broadway Street NE Suite 500, Minneapolis, MN databases, a CBB can list their units directly in the 55413, USA. E-mail: [email protected] international databases or have an established relationship Received 6 January 2010; accepted 14 January 2010; published online with a registry. In all, 94 CBBs are associated with a 1 March 2010 registry, 11 CBBs list their units directly in the international Cord blood banking, registry operations K Welte et al 826 500 of international databases. Bone Marrow Donor World- 452 450 wide lists 339 025 CBUs, the Netcord Foundation virtual 406 office 83 759, the United States National Marrow Donor 400 Program 93 767 and Asiacord lists 111 662 CBUs. It is 350 known that at least 69 816 CBUs are not listed in 300 292 international databases. Transplant centers have access to 256 250 229 these databases to search for a cord blood unit. An initial search report contains information about the units that 200 181 have the highest HLA match grade with the patient, usually 150 136 105 cord blood units are typed at the Ag level for class I and at 100 70 the allele level for DRB1 and these are sorted according to 44 50 the reported total nucleated-cell count (TNC) before

Number of cord blood units (x thousand) freezing. International recommendations from Eurocord 0 7 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 and other centers advise a minimum of 2 Â 10 TNC/kg and Year 2 Â 105 CD34 þ cells/kg of recipient body weight. Figure 1 The number of cord blood units stored worldwide. The figure By contacting the registry and asking for a ‘Cord Blood does not include the Japanese Cord Blood Network, which participated in Unit Report’ a transplant center can obtain detailed the WMDA Annual Report for the first time in 2008. The Network consists information about the CBU. This ‘Cord Blood Unit of 11 Japanese Cord Blood Banks that stored 38 426 CBU in 2008. Report’ contains information about the gender and race of the donor, TNC, HLA typing, testing done on the mother and on the CBU, collection date, processing 3,000 method, sample inventory and the type of bags used for 2,750 cryopreserving the unit. This first interaction between the 2,500 Transplant Centre and the Registry/CBB is called a 2,250 preliminary search. 2,000 Based on the information shown on the Cord Blood Unit 1,750 Report, the Transplant Centre decides whether to move to 1,500 2.825 the next step in the process, called ‘formal search’. Formal 2.743 1,250 search means that the transplant center asks for further

1,000 2.086 HLA typing of the unit and may also request additional 750 1.791 local infectious disease markers, such as human T- Number of cord blood units

500 1.126 963 lymphotropic virus and West-Nile virus, to be carried out

250 617 540 390 368 from maternal blood samples. 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 When a transplant center orders a unit, the shipment Year date is agreed between the transplant center, the registry Units provided and the CBB. Although CBUs can be shipped within a day or two for emergency orders, most CBBs prefer at least Figure 2 The number of cord blood products provided each year three to five days notice. CBBs that carry out additional worldwide. The figure does not include the Japanese Cord Blood Network, which participated in the WMDA Annual Report for the first time in 2008. pre-release viability or potency tests such as colony forming The Network consists of 11 Japanese Cord Blood Banks that provided 842 units may require up to 15 days notice. CBUs are cord blood units for transplantation in 2008. transported in a dry shipper, which holds the CBU in vapour-phase liquid nitrogen. The dry shipper is collected databases and 26 CBBs only provide units locally. The from the CBB by a courier company trained in interna- WMDA Annual Report Cord Blood Registries/Banks tional shipping and may not be irradiated for inspection. reports the activities of 122 CBBs. In 2008, 729 CBUs were Units are ordered before the patient undergoes condition- provided by independent CBBs, 733 CBUs were provided ing for the transplant procedure to ensure that the shipment locally and 2067 CBUs were provided through a registry. has been successful. The transplant center is responsible for checking the accompanying unit records when the unit arrives, unloading the shipper, checking the integrity of the Facilitation of a CBU unit and placing it in a liquid nitrogen freezer for temporary storage until the transplant date. The dry shipper is returned There are fewer steps in the release of CBU than for HSC’s to the CBB for inspection for any damage and to read the from adult donors, because CBUs are fully tested and data from the continuous temperature monitor to assure that characterized at the time they are stored and listed for the desired temperature during shipment was maintained. searches. The process is faster, because it does not require One of the advantages of a CB donor is that because the units the donor work-up activities required for marrow and are sent frozen, the transplant center can have the unit before PBSC collection. Figure 3 shows the CBU search process conditioning the patient. with recommended time frames. After the release of a CBU, CBBs are required to collect Once the CBUs are HLA typed and have been medically outcome data to fulfill regulatory or accreditation require- qualified, they can be listed for search. The stem cell donor ments. The WMDA supports the systematic collection of registries and independent CBBs list the CBUs in a number these data, as complete clinical information on the outcome

Bone Marrow Transplantation Cord blood banking, registry operations K Welte et al 827 CBB submits cord blood data to Cord blood Detailed CBU TCs Select CBU (s) for registry and CBU is preliminary report confirmatory/Identity or available in search selected by TC extended typing internatioanal performed (2 days) database

Registry CBB or central Lab Registry arranges shipment of forwards TC selected CBU to arrive 3/5 days reports typing results typing selects before patient prep starts to registry results to final CBU (8-13 days) TC

TC Registry monitors infusion and collects performs Registry verifies identity recipient follow up information through receipt of CBU at TC typing if contracted arrangement not done previously 1 Figure 3 Cord blood search process. A flow diagram of each step of the cord blood search process. of the transplant is an important indicator of the quality of infectious diseases such as the HIV and hepatitis B. In all, 8 the unit. This is also required by the accreditation program of the 42 participating Cord Blood Registries do not cover of Foundation of the Accreditation of Cellular Therapy risks for Creutzfeldt–Jakob disease, 3 do not cover malaria (FACT) and Netcord Foundation. Some CBBs have signed transmission and 1 does not cover genetic disease in the an agreement with clinical registries, such as Eurocord or donor family. the Center for International Blood and Marrow Transplant The type of tests carried out varies between the different Research, to provide clinical outcome data provided by CBBs based on their national regulations. International transplant centers to meet the regulatory needs of CBBs. standards require that infectious disease testing be done on Similar cooperation is currently being proposed with stem a maternal sample; usually it must be collected before or cell donor registries. within seven days of delivery. Some countries require additional testing of the maternal donors to be done at 6 months after delivery. Other countries require that the tests Advantages of a relationship between CBB and a registry also be performed on a sample of the CBU. The timing of other tests on the CBUs varies between the Over 70% of the CBBs have established a relationship with CBBs. Most tests are done before the registration of a unit a registry, which oversees the facilitation of the CBU. in the international database. However, some tests may be Registries have a long experience in the international carried out before shipping. An example is hemoglobino- exchange of BM and PBSC products that benefits CBBs. pathy testing, which is not done before listing units by 18 of Over 40% of the CBUs is exported to another country, in the 42 cord blood registries. 2008 1235 CBUs were provided internationally. Registries On the WMDA website (http://www.worldmarrow.org) have the infrastructure to list cord blood units in the information is provided by country on which tests are done international databases, like Bone Marrow Donors World- on the mother at time of collection, tests carried out on the wide. In addition, registries have systems in place to CBU before the unit is released, details about the mother’s coordinate data transactions including demographic, clini- health questionnaire and export information, as some cal and genetic information and lab samples and results for countries require a special permit. CBUs. One of the most complicated components is creating The CBWG has discussed several challenges the past 2 and maintaining the matching algorithm for patient years related to the differences in various processes required searches, which requires HLA expertise. This specific for CBU international exchange vs marrow and PBSC knowledge in described elsewhere in this issue. international exchange: Registries also offer knowledge of import and export requirements per country. As regulations differ from country to country, excellent communication and coopera- Listing in different databases tion is essential to ensure that all appropriate donor The national registries list their adult volunteer donors in screening questions and infectious disease tests have been one central database, Bone Marrow Donors Worldwide carried out according to the importing country’s require- (see web site www.bmdw.org). CBUs may be listed by the ments. The WMDA has a system in place to exchange this individual CBB or by the national registry. The CBUs can critical information. be listed in more than one international database and Cord blood banks have a maternal health questionnaire searchers must be aware that duplicate listings are possible. to screen donors with questions covering risk factors for There is an on-going effort by registries to identify

Bone Marrow Transplantation Cord blood banking, registry operations K Welte et al 828 duplicate sources of information and to work with Table 1 List of diseases the World Marrow Donor Association transplant centers to select the unit that best meets the (WMDA) recommends that cord blood registries and banks should patient’s needs. screen for on the Family Medical Health History Questionnaire Cancer/Leukemia Brain or other nervous system cancer Standard terminology in the communication with the Bone or joint cancer Transplant Centre Kidney cancer Thyroid cancer A CBU is a stem cell product that can be stored frozen for Hodgkin’s lymphoma many years. Standards have evolved over time. Donor Non-Hodgkin’s lymphoma, screening and processes may change over time. Obtaining Acute or chronic myelogenous/myeloid leukemia the detailed CBU information desired by a transplant Acute or chronic lymphocytic/lymphoblastic leukemia center can be time consuming and subject to terminology Skin cancer and communication gaps across international boundaries. Blood disorders—red blood cell disease One important accomplishment of the CBWG was to adopt Diamond–Blackfan syndrome a comprehensive standard CBU report that can be used by Elliptocytosis any CBB in the world. A report template is found on the Spherocytosis WMDA web site. If the CBB has done additional testing a Blood disorders—WBC disease supplemental CBU Report Template is available on the Chronic granulomatous disease WMDA web site (http://www.worldmarrow.org). Immune deficiencies ADA or PNP deficiency Combined immunodeficiency syndrome Common variable immunodeficiency Mother’s health questionnaire DiGeorge’s syndrome One of the activities of the CBWG was to gather Hereditary hemophagocytic lymphohistiocytosis including FEL information about diseases that CBBs should include in Nezeloff’s syndrome the maternal health questionnaire. A total of 18 cord blood SCID registries noted which diseases from different categories Wiskott–Aldrich syndrome would cause units to be excluded when they occurred in the Blood disorders—plt disease baby’s immediate relatives (Table 1). Amegakaryocytic thrombocytopenia Glanzmann’s thrombasthenia Hereditary thrombocytopenia Plt storage pool disease Limited contiguous segments Thrombocytopenia with absent radii One unique aspect of CBUs is that there are limited Ataxia-telangiectasia additional samples available to carry out HLA typing Fanconi’s anemia when requested by a transplant center. The most valuable Metabolic/storage diseases sample type is the small segment that is stored attached Prophyria to the CBU, called a contiguous segment. This is the only sample type that can definitively assure that the Severe autoimmune disorder HLA typing in the unit is what was reported for listing the Crohn’s disease or ulcerative colitis CBU. The number of contiguous segments is limited (one Systemic lupus erythematosus Multiple sclerosis to three small volume segments for a CBU). When all contiguous segments have been exhausted, the likelihood Monogeneic diseases that the CBU will be ordered in future is low. Today, Myasthenia gravis WMDA guidelines are in place about how attached Celiac disease segments should be used to provide the best information Other questions to transplant centers and protect the value of the CBU for Required chronic blood transfusions the CBB. Creutzfeldt–Jakob disease (CJD) The CBWG has defined two HLA typing categories: Infected with HIV/AIDS extended typing, which can be done on any CBU sample; History of abnormal prenatal testing in donor mother and identity typing, which is performed from a contiguous Baby’s mother segment. These results are reported to the transplant center Diseases rejected by all respondents and to the CBB. When there is only one segment for a unit, Chronic granulomatous disease the segment generally stays with the unit when shipped. The Glanzmann’s thrombasthenia Hereditary thrombocytopenia final identity typing can then be carried out by the Plt storage pool disease transplant center before the unit is thawed. Thrombocytopenia with absent radii Older units may not have contiguous segments; thus, Ataxia-telangiectasia additional samples that are not attached to the CBU need Fanconi’s anemia to be used for HLA typing. Furthermore, other DNA Diseases rejected by 90% of respondents based genetic markers (for example, STRs) should be Brain or other nervous system cancer considered to confirm the relationship of the samples to the Bone or joint cancer CBU. Registries and CBBs should notify the transplant Kidney cancer center when there is no segment available for testing. Thyroid cancer

Bone Marrow Transplantation Cord blood banking, registry operations K Welte et al 829 Table 1 Continued Table 1 Continued

Hodgkin’s lymphoma G6PD or other red cell enzyme deficiency Non-Hodgkin’s lymphoma Spherocytosis Acute or chronic myelogenous/myeloid leukemia Chronic granulomatous disease Acute or chronic lymphocytic/lymphoblastic leukemia Kostmann’s syndrome Skin cancer Schwachman–Diamond syndrome Diamond–Blackfan syndrome Leukocyte adhesion deficiency Elliptocytosis ADA or PNP deficiency Spherocytosis Combined immunodeficiency syndrome Immune deficiencies Common variable immunodeficiency ADA or PNP deficiency Hypoglobinulinemia Combined immunodeficiency syndrome Nezeloff’s syndrome Common variable immunodeficiency SCID DiGeorge’s syndrome Wiskott–Aldrich syndrome Hereditary hemophagocytic lymphohistiocytosis including FEL Sanfilippo’s syndrome Nezeloff’s syndrome Morquio’s syndrome SCID Adrenoleukodystrophy Wiskott–Aldrich syndrome Tay–Sachs disease Amegakaryocytic thrombocytopenia Gaucher’s disease Prophyria Prophyria Infected with HIV/AIDS Crohn’s disease or ulcerative colitis Baby’s sibling Systemic lupus erythematosus Diseases rejected by 90% of respondents Multiple sclerosis Glanzmann thrombasthenia Myasthenia gravis Hereditary thrombocytopenia Celiac disease Platelet storage pool disease Required chronic blood transfusions Thrombocytopenia with absent radii Creutzfeldt–Jakob disease (CJD) Ataxia-telangiectasia Fanconi Anemia Diseases rejected by 80% of respondents G6PD or other red cell enzyme deficiency Diseases rejected by 80% of respondents Kostmann’s syndrome Diamond–Blackfan syndrome Schwachman–Diamond syndrome G6PD or other red cell enzyme deficiency Leukocyte adhesion deficiency Chronic granulomatous disease Hypoglobinulinemia Kostmann’s syndrome Sickle cell disease, such as sickle-cell anemia or sickle thalassemia Leukocyte adhesion deficiency Thalassemia, such as alpha thalassemia or beta-thalassemia Immune deficiencies Hurler–Scheie syndrome ADA or PNP deficiency Hunter’s syndrome Combined immunodeficiency syndrome Sanfilippo’s syndrome Common variable immunodeficiency Morquio’s syndrome DiGeorge’s syndrome Maroteaux–Lamy syndrome Hereditary hemophagocytic lymphohistiocytosis including FEL Sly’s syndrome Hypoglobinulinemia I-cell disease Nezeloff’s syndrome Krabbe’s disease SCID metachromatic leukodystrophy Wiskott–Aldrich syndrome adrenoleukodystrophy Amegakaryocytic thrombocytopenia Sandhoff’s disease Sanfilippo’s syndrome Tay–Sachs disease Morquio’s syndrome Gaucher’s disease Tay–Sachs disease Niemann–Pick disease Gaucher’s disease Rheumatoid arthritis Niemann–Pick disease Type I diabetes Prophyria Duchene’s muscular dystrophy Cystic fibrosis Questions asked by at least 80% of the respondents: Hemolytic anemia Does your registry inquire if the mother has a history of abnormal prenatal Spleen removed to treat a blood disorder testing? Does your registry inquire if the mother had any children die in childhood? Baby’s father Does your registry inquire if the mother had any stillborn children? Diseases rejected by 90% of respondents Does your registry perform routine follow-up of the infant donor post Diamond–Blackfan syndrome donation? Immune deficiencies DiGeorge’s syndrome Hereditary hemophagocytic lymphohistiocytosis including FEL Amegakaryocytic thrombocytopenia Reservation policies Glanzmann’s thrombasthenia hereditary thrombocytopenia Reservation policies vary among the CBBs. A survey Plt storage pool disease carried out by the WMDA showed that the time period that Thrombocytopenia with absent radii CBBs reserve a unit for a specific patient varies between 30 Ataxia-telangiectasia and 90 days. Over 40% of the cord blood registries release Fanconi’s anemia units for searching automatically after this time. Reserva- Diseases rejected by 80% of respondents tion extensions from 14 to 90 days are permitted if Elliptocytosis requested. One of the future goals of the CBWG is to

Bone Marrow Transplantation Cord blood banking, registry operations K Welte et al 830 develop a reservation form for transplant centers to clarify collection of recipient outcome data in a data collection the timelines and the details of how to move from a formal registry (for example, Eurocord Registry, Center for Inter- search process to the final step of ordering a particular unit. national Blood and Marrow Transplant Research). The following information should be obtained to evaluate the Selection of a cord blood donor processes: the number of TNC and CD34 þ , viability after The selection of a unit is the responsibility of the transplant thawing, method of thawing and adverse events at infusion. center. The best indicators of a CBU’s content are cell A second parameter for quality of CBUs is whether a counts measured post-processing, before cryopreservation unit comes from an accredited cord blood registry or not. and then before the release of the CBU on a segment. Three international organizations offer accreditation pro- One of the areas where the CBWG has tried to gather grams and actively collaborate to promote high quality and exchange information is around the factors that are CBUs; the WMDA, Netcord Foundation in collaboration involved in the selection of CBUs. Although, the specific with FACT and the American Association of Blood Banks. requirements varied according to the transplant pro- All these organizations are involved in the Alliance for grammes, published data both in Europe and in the United Harmonisation of Cellular Therapy Accreditation and are States indicate the importance of TNC content per working on setting harmonized standards on an interna- kilogram of patient weight in reduced-intensity and tional basis. Each accreditation program covers different myeloablative conditioning stem cell transplants for both aspects of unrelated cord blood transplantation. The main single and double cord blood transplantation. Also with objective of the Netcord–FACT accreditation is to evaluate regard to the HLA match status, it has been found that a aspects of CBB including donor selection, methods of 0–1 mismatch is preferable to a 2 mismatch and that 3–4 collection, processing, testing and storage of the units and mismatches should be avoided for almost all patients. The release and transportation of the CBUs to the transplant third important factor is to identify whether the donor is centers. American Association of Blood Banks developed selected for transplantation into a patient with malignant high-quality standards on the area of cord blood collection, or non-malignant disease, as the effect of the TNC and storage and distribution. The WMDA Accreditation HLA may differ.3 Program focuses on the registry operations. More detailed information about the WMDA Accreditation Program is described elsewhere in this issue. Transport of CBUs around the globe These accreditation schemes address some different The 56 cord blood registries participating in the WMDA aspects of cord blood banking, listing and transplantation, annual report reported 44 transport incidents in 2008 (1.5% and they all refer to each other for complementary of the shipments). In 22 cases the CBU bag arrived at the requirements. For example, the WMDA Standards states transplant center cracked, torn or otherwise unusable ‘If a Registry relies on an independent Donor Center or because of transportation. Ten times the CBU arrived Cord Blood Bank to recruit and characterize donors, the thawed, five times custom officers opened the dry shipper Registry must ensure that the Donor Center/Cord Blood and seven times the courier delivered the dry shipper at the Bank complies with relevant WMDA standards’. In this wrong address. The WMDA registries report serious case, requiring accreditation of the cord blood bank by an transport problems to the WMDA Serious Product Events organization such as Netcord–FACT might be one means and Adverse Effects Registry, where the trends are by which the registry ensures that this WMDA standard monitored (for example, where a specific airport always can be met. The Netcord–FACT standards describe the opens the dry shipper). More information about Serious requirement in another way: ‘If a CBB utilizes a registry to Product Events and Adverse Effects Registry can be found deliver services related to the listing, search and selection, elsewhere in this issue. reservation, and/or release of a CBU the registry should be The WMDA recommends that the temperature of the accredited by the WMDA’. A list of accredited cord blood CBU is monitored with a continuous monitor device during banks and cord blood registries can be found on the the shipment of the CBU to assure that the unit websites of the FACT Office (www.factwebsite.org), temperature continues to be maintained at or below American Association of Blood Banks (www.aabb.org) À150 1C to protect the unit from premature thawing. Use and WMDA. of the older minimum temperature single use indicators Historically, the policies and procedure to collect, does not meet the current standards. process and store cord blood differed among CBBs. There also remain differences today in processes used by different Quality of CBUs CBBs and processes required by different countries. The An important aspect of the banking and shipping of CBUs development and implementation of international stan- for clinical use is the quality control monitoring of the unit dards allows more CBBS to become accredited and for in all phases of its collection, preservation, and shipment; procedures to become more consistent across the world. the quality control measures are a requirement of Netcord– FACT accreditation. The quality, safety and efficiency of a CBU for clinical transplantation are a priority for the Challenges in the international exchange of CBUs and WMDA and the CBWG is approaching this issue in several future directions for the cord blood-working group ways. Complete clinical information on the outcome of the transplant provides important information about the Although cord blood banking and cord blood transplanta- quality of the CBU. The WMDA supports the systematic tion have become more standardized, there are still a

Bone Marrow Transplantation Cord blood banking, registry operations K Welte et al 831 number of challenges ahead. One of these relates to the Blood Unit Storage’ that describes three different CBB possibility of improving the search procedures developed models: unrelated/public, related/directed and autologous/ by all the various organizations listing CBUs. As part of private models. The statement is available on the WMDA this, representatives of the WMDA CBWG met for the first web site. time with representatives of Netcord Foundation, Bone Finally, the future clinical use of other cellular products Marrow Donors Worldwide, European Marrow Donor derived from cord blood, such as MSCs or regulatory T Information System, National Marrow Donor Program cells will also be monitored to assess the need for the and Eurocord to consider the possibility of having a unified development of new guidelines or procedures. global search. The CBWG will continue identifying new ways to improve the speed and efficiency of the current cord blood search process and reviewing the number of Conflict of interest forms currently used for various aspects involved in the international exchange of CBUs and to better meet the The authors declare no conflict of interest. expectations and needs of transplant centers. An agreement has recently been reached by these organizations to share and exchange information throughout the world. A new References telematic development is currently underway between National Marrow Donor Program, Center for Interna- 1 Gluckman E, Broxmeyer HE, Auerbach AD, Friedman HS, tional Blood and Marrow Transplant Research, EBMT Douglas GW, Devergie A et al. Hematopoietic reconstitution in and Eurocord to develop a telematic tool for outcome data a patient with Fanconi’s anemia by means of umbilical-cord exchange (A Growable Network Information System). blood from an HLA-identical sibling. N Engl J Med 1989; 321: Another important challenge is the increasing number of 1174–1178. private, usually for-profit CBBs storing autologous units 2 Rubinstein P, Taylor PE, Scaradavou A, Adamson JW, that may wish to allow some units to be made available Migliaccio G, Emanuel D et al. Unrelated placental blood for bone marrow reconstitution: organization of the placental through a public allogeneic CBB. The CBWG has been blood program. Blood Cells 1994; 20: 587–600. discussing this issue with the Ethics Working Group and a 3 Rocha V, Gluckman E. Improving outcomes of cord blood public statement about these so-called hybrid CBB models transplantation: HLA matching, cell dose and other graft- and is being completed. The CBWG developed a ‘Policy transplantation-related factors. British J of Haematol 2009; 147: Statement on the Utility of Autologous or Family Cord 262–274.

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