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 Prepublished online as a Blood First Edition Paper on April 10, 2003; DOI 10.1182/blood-2003-03-0720.

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Submitted March 10, 2003
Accepted April 2, 2003

Cord blood transplantation provides better reconstitution of hematopoietic reservoir as compared to bone marrow transplantation

Francesco Frassoni*, Marina Podesta', Rita Maccario, Giovanna Giorgiani, Gabriele Rossi, Marco Zecca, Giovanna Piaggio, and Franco Locatelli

Centro Cellule Staminali e Terapia Cellulare, Dipartimento Emato-Oncologia, Ospedale San Martino, Genova, Italy
Onco-Ematologia Pediatrica, IRCCS Policlinico San Matteo, Pavia, Italy

* Corresponding author; email: francesco.frassoni{at}hsanmartino.liguria.it.

Delayed hematopoietic recovery is the main factor precluding a wider use of cord blood (CB) transplants. We hypothesized that this delayed engraftment might not be related to an insufficient number of stem cells in the graft, but to an intrinsic difficulty of these cells to undergo differentiation. To test our hypothesis, two groups of children were compared: 12 received a CB transplant and 12 an adult bone marrow (BM) transplant. We studied neutrophil and platelet recovery and, at a median time of approximately one year after transplantation, the frequency of colony forming cells (CFC) and long-term culture initiating cells (LTC-IC) in the BM of the 2 groups. BM transplant recipients received 1-log more cells and had significantly faster neutrophil and platelet recovery. Conversely, the frequency of committed and early progenitors was significantly higher in the marrow of children given CB cells as compared to BM transplant recipients (median CFC/2x104 BM mononuclear cells 20 versus 11 p=0.007; median LTC-IC/106 BM mononuclear 8.2 versus 0.2 p=0.001). CB, but not adult BM stem cells, can better restore host hematopoietic progenitor cell reservoir; the delayed engraftment after CB transplantation may reflect the difficulty of CB progenitors to reprogram themselves toward differentiation.


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