Alternate Donor Sources Unrelated cord blood stem cells

Unrelated cord blood (UCB) cell transplantation has been used successfully to treat pediatric and smaller adult patients.99 101-103 Patients receiving HLA mismatched related and UCB transplants have a lower rate of severe acute GVHD and mortality than is observed in marrow transplants with a similar level of HLA mis-match.101 Stem cell or nucleated cell dose is critical to successful engraftment and is the most important factor affecting patient survival in cord trans-plants.99 101-103 However, minimizing HLA mismatches is still important in cord transplants. Rubinstein and

Stevens103 reported that risk of severe acute GVHD correlated with HLA mismatch. Considering HLA-A, -B (antigen level) and -DRB1* matching, severe GVHD was seen in 8, 19, and 28% for 6/6, 5/6, and <4/6 HLA mismatches, respectively.

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