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Immune Reconstitution After Cord Blood Transplantation

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Cord Blood Transplantations

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Abstract

Umbilical cord blood (UCB) is a valuable alternative source of hematopoietic stem and progenitor cells (HSPCs) for patients in need of allogeneic hematopoietic stem cell transplantation (HSCT), who lack suitable human leukocyte antigen (HLA)-matched adult donors. Compared to peripherally mobilized or bone marrow, HSPC units from unrelated adult donors, UCB grafts have the advantage of immediate availability, absence of risk to the donors and lower immunogenicity, which allows for a greater degree of HLA incompatibility. However, UCB grafts contain a lower number of nucleated cells and mostly naïve T cells that do not transfer protective T-cell memory, resulting in delayed engraftment and immune reconstitution, especially in the early posttransplant period. As a result, control of viral infections remains a challenge, and patients undergoing UCB transplantation (UCBT) are at increased risk for infectious complications and mortality. In this chapter, we will review the unique characteristics of UCB grafts, the factors that account for the pattern and kinetics of immune reconstitution after UCBT, and the significance of the adaptive immune system recovery for long-term outcomes in adult recipients of UCBT.

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Abbreviations

ALC:

Absolute lymphocyte count

CMV:

Cytomegalovirus

CTL:

Cytolytic T-cell

CTLA-4:

Cytotoxic T-lymphocyte-associated (protein) 4

EBV:

Epstein-Barr virus

FLT3:

Fms-related tyrosine kinase 3

HHV-6:

Human herpesvirus 6

HLA:

Human lymphocyte antigen (system)

IFN-γ:

Interferon-γ

IL-2:

Interleukin-2

IL-4:

Interleukin-4

IL-7:

Interleukin-7

IL-10:

Interleukin-10

IL-15:

Interleukin-15

IL-22:

Interleukin-22

KGF:

Keratinocyte growth factor

LHRH-A:

Luteinizing hormone-releasing hormone analog

LMP:

Lymphoid-myeloid progenitors

LPS:

Lipopolysaccharide

NFAT:

Nuclear factor of activated T-cells

NK:

Natural killer

NSG:

NOD SCID gamma (mouse strain)

RTE:

Recent thymic emigrants

SCF:

Stem cell factor

sIgM:

Surface immunoglobulin M

Tc1/2:

T cytotoxic 1/T cytotoxic 2

TEC:

Thymic epithelial cells

TGF-β:

Transforming growth factor-β

Th1/2:

T helper 1/ T helper 2

TNF-α:

Tumor necrosis factor-α

TREC:

T-cell receptor excision circles

Treg:

T regulatory

VZV:

Varicella zoster virus

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Authors and Affiliations

  1. Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA

    Ioannis Politikos

  2. Division of Hematology-Oncology, Harvard Medical School, Boston, MA, 02215, USA

    Vassiliki A. Boussiotis

  3. Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA

    Vassiliki A. Boussiotis

  4. Beth Israel Deaconess Cancer Center, Harvard Medical School, Boston, MA, 02215, USA

    Vassiliki A. Boussiotis

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  1. Ioannis Politikos
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Correspondence to Vassiliki A. Boussiotis .

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  1. Duke Cancer Center, Duke University, Durham, North Carolina, USA

    Mitchell Horwitz

  2. Duke Cancer Center, Duke University, Durham, North Carolina, USA

    Nelson Chao

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Politikos, I., Boussiotis, V.A. (2017). Immune Reconstitution After Cord Blood Transplantation. In: Horwitz, M., Chao, N. (eds) Cord Blood Transplantations. Advances and Controversies in Hematopoietic Transplantation and Cell Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-53628-6_12

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