Public Cord Blood Banking at the National Cord Blood Program (NCBP) A. Scaradavou, MD Medical Director, National Cord Blood Program, New York Blood Center Associate Attending, Pediatric BMT Memorial Sloan-Kettering Cancer Center 1
CB as hematopoietic stem cell graft The blood remaining in the placenta and umbilical cord after the birth of baby is rich is hematopoietic stem cells This blood can be harvested easily, with no risk to the mother or baby Advantages of CB in transplantation Easy access large numbers of donors ethnic diversity Can be collected and stored (cryopreserved) in CB Banks Available upon demand no delays in transplants Lower risk of viral infections Immunologically naïve T cells: do not need perfect match Considerations Cell dose (volume) Transmission of (unknown) diseases Antileukemic effect 2
Background: CB Collection Models In Utero Collection: after delivery of newborn; placenta still in utero Ex Utero Collection: placenta delivered and removed from delivery room; collection performed by trained technologists Ex utero CB collection CB collection kit 3
Cord Blood Collection (NCBP) Ex utero collection Trained collection personnel Placenta TNC count at collection - Identification of clinical units Maternal Consent - sample - Questionnaire - Records Umbilical Cord Transportation to the Bank - temperature monitoring Time from collection to completion of processing: maximum 36 hours Cord Blood Unit 4
What is a bankable CBU Adequate TNC (volume): above Bank s cut-off Not Clotted Maternal informed consent medical information No Contamination with Bacteria/Fungi No Contamination with Mother s Blood Processed within 36 hours* from collection Adequate / Viable Hematopoietic Progenitor Cells Complete infectious disease testing *FACT requires maximum of 48 hrs from collection 5
Background: CB Processing Methods Manual or Automatic Processing Closed System or Open System Volume Reduction Only Red Cell Depletion Only Plasma and RBC reduced 6
Cord Blood Processing (NCBP) Plasma RBCs MNCs AXP: Automated Processing System Partial RBC depletion and volume reduction Closed manufacturing system; Aseptic processing Accurate final product volume; Consistent, low hematocrit High recovery of mononuclear and CD34+ cells; excellent viability 7
Cord Blood freezing and storage Two-compartment Cryopreservation Bag; total volume: 25 ml HPC-C cryoprotected in DMSO; final DMSO concentration: 10% 2 1 Segments: identity and potency testing post-cryopreservation 1: HLA Confirmatory Typing; 2: CD34+ count/viability, CFU testing 3: retention sample 8
Cord Blood cryopreservation CB storage - storage BioArchive freezer Individual CBU: controlled rate freezing (CRF) long-term storage in liquid nitrogen in the same freezer reduced transient warming events automated retrieval Standardization: highly reproducible cryopreservation profiles computerized system Capacity: 3600 HPC, Cord Blood products 9
Cord Blood Testing Maternal blood sample: donor ID screening including NAT for HIV/HCV/HBV and WNV, and testing for CMV CB: CBC, CD45 + /CD34 + cells and viability, CFU assays CB: ABO, Rh, SS hemoglobin (HPLC); molecular Hb testing as needed CB: Bacteriology (bacterial, fungal, aerobic, anaerobic) CB: Testing for relevant genetic diseases can be performed prior to transplant HLA typing (class I, II performed at the DNA level) 10
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vcd34/ml 10^3 Potency: CFU counts and vcd34+ cells N=11,587 CBU, post-processing samples 2500 2000 R²= 0.76 Y=1.4x + 0.86 1500 1000 500 0 0 200 400 600 800 1000 CFU/ ml 10^3 12
The life cycle of a clinical CBU Permission to collect - review medical record Harvest CB TNC Total Nucleated Cell count at collection Research CBU No identifiers No further tests Label CBU - Clinical - Informed consent maternal questionnaire Processing - Cryopreservation - Freezing Testing: Potency, IDMs, eligibility, HLA, other QA Review: CBU Release to Search (status) Review for patient: TNC/match HLA CT from segment CBU Release for Transplant 13
Cord Blood Shipping - Transportation Shipping container CB Unit CryoShipper Lid Continuous temperature monitoring during transportation Shipping Container CB Unit MVE Data logger < -150 C for 5-7 days -190 C 14
NCBP HPC, Cord Blood: final product Highly regulated stem cell source Accreditations: FACT or AABB FDA Regulations (Public CB Banks) 15
HEMACORD: NCBP FDA licensed product November 2011: First stem cell product to be licensed Indications for use: hematopoietic progenitor cell reconstitution 16
HPC, Cord Blood Stability Studies Stability studies of CB products: a) Does the time in storage affect potency or engraftment ability b) Is there an expiration date for the products? 17
Manufacturing Expiration Date PRODUCT NAME Example: Labeling NEW CONTAINER LABEL APPLIED AT SHIPMENT PARTIAL LABEL PRINTED AT SHIPMENT EXPIRATION DATE 18
Access to the NCBP CB Inventory NCBP s Web portal: WebSearch Registries: Single Point of Access NMDP Distributed Search Bone Marrow Donors Worldwide 19
Unrelated Donor Searches: Results based on patient Ancestry CB extends transplant access to patients of ethnic minorities NW Europe Eastern Europe Data from Memorial Sloan-Kettering Cancer Center Barker et al, BBMT 2010; 16(11):1541-1548 Howard P. Milstein National Cord Blood Center
Search, Evaluation and Acquisition of CBU for unrelated transplantation Well trained, dedicated transplant search coordinators Clear, step-by-step procedures for search, evaluation and CBU selection for transplant Communication between search coordinators, clinical teams and Stem Cell Lab 21
CBU selection for unrelated transplantation: considerations Quality - Potency of CBU TNC dose; CD34+ cell dose and viability, CFU assays Patient - CBU HLA match level Interaction of TNC - HLA match Allele level matching (HLA-A, -B, -C, -DRB1) Selection of CBU with permissible mismatches Other immunological considerations HLA and relapse; Donor-specific antibodies; KIR-L CBU quality post-thaw Standardization of banking practices CBU stability studies and segment evaluation Other CBU characteristics - Banking aspects RBC depletion - final hematocrit Cryopreservation volume/bag, storage time 22
Factors Associated with Low CD34+ Cell Viability Variable (N) N (%) < 75% CD34+ Viability FACT accreditation at unit collection Yes (n = 259) 8 (3%) No (n = 143) 25 (18%) Year of cryopreservation 1997 2004 (n = 119) 17 (14%) 2005 2012 (n = 283) 16 (6%) Cryo. volume (ml) < 24.0 (n = 10) 3 (30%) 24.0 26.0 (n = 302) 10 (3%) 26.1 30.0 (n = 35) 5 (14%) > 30.0 (n = 55) 15 (27%) Processing method Manual (n = 188) 24 (13%) Automated + semiautomated (n = 214) 9 (7%) Univariate p value Multivariate p value < 0.001 < 0.001 0.008 NS < 0.001 0.001 0.002 0.010 Purtill et al, Blood 2014; 124: 2905-2912
Transplant Center Stem Cell Lab Method for CBU preparation for infusion: wash or albumin dilution final volume validated method Post-thaw evaluation studies 24
Acknowledgements National Cord Blood Program: Collections - Rodica Ciubotariu, MD, PhD Quality Control - Susana Albano, PhD IT Systems - Michal Tarnawski, MD Manufacturing - Ludy Dobrila, PhD Medical Director - Andromachi Scaradavou, MD Program Director - Pablo Rubinstein, MD 25