Correspondence

Creation of a Double Chimera after the Transplantation of Umbilical-Cord Blood from Two Partially Matched Unrelated Donors

N Engl J Med 2001; 344:1870-1871June 14, 2001

Article

To the Editor:

Despite promising outcomes in the transplantation into pediatric recipients of umbilical-cord blood from unrelated donors, the low cell dose adversely affects both the rate of hematopoietic recovery and the probability of survival.1-3 The cell dose is a major limitation of the procedure, particularly in adults. An alternative to the ex vivo expansion of cells, which has yet to be shown to be efficacious, is the transplantation of 2 closely HLA-matched units of umbilical-cord blood.

We transplanted 2 units of umbilical-cord blood from male infant donors into a 53-year-old, 84-kg woman with accelerated-phase chronic myelogenous leukemia and no bone marrow donor. The units were mismatched with the patient at both HLA-DRB1 alleles and mismatched with each other at one HLA-DRB1 allele. The infused doses of cells were 0.7×10⁷ (Donor 1) and 0.9×10⁷ (Donor 2) nucleated cells per kilogram of the recipient's body weight. Conditioning consisted of cyclophosphamide (120 mg per kilogram), fractionated total-body irradiation (1320 cGy), and antithymocyte globulin, with prophylaxis against graft-versus-host disease consisting of cyclosporine and methylprednisolone as previously described.4 Granulocyte colony-stimulating factor (5 μg per kilogram) was given daily from day 0 until neutrophil engraftment occurred. Neutrophil recovery (as defined by an absolute neutrophil count of more than 5×10⁸ per liter) occurred on day 25. Bone marrow biopsies on days 21 and 55 revealed 97 percent and 98 percent donor cells, respectively, each with 20 of 20 cells in metaphase of male origin. The contribution of each graft to hematopoiesis after transplantation was assayed by analysis of restriction-fragment–length polymorphisms (Table 1Table 1Contribution of the Two Umbilical-Cord Blood Grafts to Hematopoiesis after Transplantation.).

Transplantation with two immunologically distinct units of umbilical-cord blood can be associated with engraftment, with each unit contributing to hematopoiesis for at least 60 days after transplantation. Consistent with the data in preimmune sheep,5 these findings suggest that crossed immunologic rejection between the units of umbilical-cord blood may not occur.

Our results contrast with those of previous studies in which the cells from only one of multiple donors of bone marrow6 or umbilical-cord blood7 engrafted. Unlike those studies, our study used units that were relatively closely matched.

Unfortunately, despite a normal neutrophil count and the absence of graft-versus-host disease, disseminated aspergillus infection developed in the patient, who died 68 days after transplantation. Nonetheless, our findings should prompt further investigation of the transplantation of umbilical-cord blood from two partially HLA-matched donors as a method of increasing the dose of cells, particularly for adult recipients. Furthermore, in the future, this approach may facilitate the evaluation of the efficacy of culture for ex vivo expansion in which 1 of 2 units of umbilical-cord blood is expanded.

J.N. Barker, M.B., B.S.
D.J. Weisdorf, M.D.
J.E. Wagner, M.D.
University of Minnesota, Minneapolis, MN 55455

7 References

1. 1

   Wagner JE, DeFor T, Rubinstein P, Kurtzberg J. Transplantation of unrelated donor umbilical cord blood (UCB): outcomes and analysis of risk factors. Blood 1997;90:398a-398a abstract.
   

2. 2

   Gluckman E, Rocha V, Boyer-Chammard A, et al. Outcome of cord-blood transplantation from related and unrelated donors. N Engl J Med 1997;337:373-381
   Full Text | Web of Science | Medline

3. 3

   Rubinstein P, Carrier C, Scaradavou A, et al. Outcomes among 562 recipients of placental-blood transplants from unrelated donors. N Engl J Med 1998;339:1565-1577
   Full Text | Web of Science | Medline

4. 4

   Wagner JE, Rosenthal J, Sweetman R, et al. Successful transplantation of HLA-matched and HLA-mismatched umbilical cord blood from unrelated donors: analysis of engraftment and acute graft-versus-host disease. Blood 1996;88:795-802
   Web of Science | Medline

5. 5

   Zanjani E, Almeida-Porada G, Hangoc G, Broxmeyer HE. Enhanced short term engraftment of human cells in sheep transplanted with multiple cord bloods: implications for transplantation of adults. Blood 2000;96:552a-552a abstract.
   Web of Science

6. 6

   Mathe G, Amiel JL, Schwarzenberg L, et al. Bone marrow transplantation in man. Transplant Proc 1969;1:16-24
   Web of Science | Medline

7. 7

   Weinreb S, Delgado JC, Clavijo OP, et al. Transplantation of unrelated cord blood cells. Bone Marrow Transplant 1998;22:193-196
   CrossRef | Web of Science | Medline

Citing Articles (70)

Citing Articles

1. 1

   Oana Paun, Hillard M. Lazarus. (2011) Novel Transplant Strategies in Adults with Acute Leukemia. Hematology/Oncology Clinics of North America 25:6, 1319-1339
   CrossRef

2. 2

   Michael Uhlin, Darius Sairafi, Sofia Berglund, Sarah Thunberg, Jens Gertow, Olle Ringden, Mehmet Uzunel, Mats Remberger, Jonas Mattsson. (2011) Mesenchymal Stem Cells Inhibit Thymic Reconstitution After Allogeneic Cord Blood Transplantation. Stem Cells and Development111012114854001
   CrossRef

3. 3

   A. Ruggeri, R. Peffault de Latour, M. Carmagnat, E. Clave, C. Douay, J. Larghero, J.-M. Cayuela, R. Traineau, M. Robin, A. Madureira, P. Ribaud, C. Ferry, A. Devergie, D. Purtill, C. Rabian, E. Gluckman, A. Toubert, G. Socié, V. Rocha. (2011) Outcomes, infections, and immune reconstitution after double cord blood transplantation in patients with high-risk hematological diseases. Transplant Infectious Disease 13:5, 456-465
   CrossRef

4. 4

   Pedro Z. Andrade, Cláudia Lobato da Silva, Francisco dos Santos, Graça Almeida-Porada, Joaquim M.S. Cabral. (2011) Initial CD34+ cell-enrichment of cord blood determines hematopoietic stem/progenitor cell yield upon Ex vivo expansion. Journal of Cellular Biochemistry 112:7, 1822-1831
   CrossRef

5. 5

   Angel Guerra-Marquez, Barbara Novelo-Garza, Araceli Malagón-Martínez, Alejandro Limon-Flores, Fernando Luna-Bautista, Luis Juan-Shum, Ines Montero-Ponce, Elizabeth Sanchez-Valle, Karina Peñaflor, Maria Antonieta Vélez-Ruelas, Yanin Romero-Juárez, Hector Mayani. (2011) Cord blood banking and transplantation at the Mexican Institute of Social Security: the first 5 years. Transfusion 51:2, 328-332
   CrossRef

6. 6

   D. H. McKenna, C. G. Brunstein. (2011) Umbilical cord blood: current status and future directions. Vox Sanguinis 100:1, 150-162
   CrossRef

7. 7

   Philippe Taupin. (2010) Transplantation of cord blood stem cells for treating hematologic diseases and strategies to improve engraftment. Therapy 7:6, 703-715
   CrossRef

8. 8

   J. Gertow, S. Berglund, M. Okas, M. Uzunel, L. Berg, K. Kärre, J. Mattsson, M. Uhlin. (2010) Characterization of long-term mixed donor-donor chimerism after double cord blood transplantation. Clinical & Experimental Immunology 162:1, 146-155
   CrossRef

9. 9

   Jun Hayakawa, Elizabeth G. Joyal, Jean F. Gildner, Kareem N. Washington, Oswald A. Phang, Naoya Uchida, Matthew M. Hsieh, John F. Tisdale. (2010) 5% Dimethyl sulfoxide (DMSO) and pentastarch improves cryopreservation of cord blood cells over 10% DMSO. Transfusion 50:10, 2158-2166
   CrossRef

10. 10

    S.S. Tung, S. Parmar, S.N. Robinson, M. De Lima, E.J. Shpall. (2010) Ex vivo expansion of umbilical cord blood for transplantation. Best Practice & Research Clinical Haematology 23:2, 245-257
    CrossRef

11. 11

    H Yang, S N Robinson, J Lu, W K Decker, D Xing, D Steiner, S Parmar, N Shah, R E Champlin, M Munsell, A Leen, C Bollard, P J Simmons, E J Shpall. (2010) CD3+ and/or CD14+ depletion from cord blood mononuclear cells before ex vivo expansion culture improves total nucleated cell and CD34+ cell yields. Bone Marrow Transplantation 45:6, 1000-1007
    CrossRef

12. 12

    Vanderson Rocha, Alessandro Crotta, Annalisa Ruggeri, Duncan Purtill, Karim Boudjedir, Andree-Laure Herr, Irina Ionescu, Eliane Gluckman. (2010) Double cord blood transplantation: extending the use of unrelated umbilical cord blood cells for patients with hematological diseases. Best Practice & Research Clinical Haematology 23:2, 223-229
    CrossRef

13. 13

    Richard L. Haspel, Karen K. Ballen. 2010. Cord Blood Transplants: Perinatal Stem Cells in Clinical Practice. , 1-19.
    CrossRef

14. 14

    Robert R. Jenq, Marcel R. M. van den Brink. (2010) Allogeneic haematopoietic stem cell transplantation: individualized stem cell and immune therapy of cancer. Nature Reviews Cancer 10:3, 213-221
    CrossRef

15. 15

    Claudio G. Brunstein, Mary J. Laughlin. (2010) Extending Cord Blood Transplant to Adults: Dealing With Problems and Results Overall. Seminars in Hematology 47:1, 86-96
    CrossRef

16. 16

    Rachael Hough, Nicola Cooper, Paul Veys. (2009) Allogeneic haemopoietic stem cell transplantation in children: what alternative donor should we choose when no matched sibling is available?. British Journal of Haematology 147:5, 593-613
    CrossRef

17. 17

    Sofia Berglund, Mantas Okas, Jens Gertow, Michael Uhlin, Jonas Mattsson. (2009) Stable mixed donor–donor chimerism after double cord blood transplantation. International Journal of Hematology 90:4, 526-531
    CrossRef

18. 18

    C G Brunstein, D J Weisdorf. (2009) Future of cord blood for oncology uses. Bone Marrow Transplantation 44:10, 699-707
    CrossRef

19. 19

    S S Kelly, C B S Sola, M de Lima, E Shpall. (2009) Ex vivo expansion of cord blood. Bone Marrow Transplantation 44:10, 673-681
    CrossRef

20. 20

    Cristina Navarrete, Marcela Contreras. (2009) Cord blood banking: a historical perspective. British Journal of Haematology 147:2, 236-245
    CrossRef

21. 21

    David Steiner, Juri Gelovani, Barbara Savoldo, Simon N. Robinson, William K. Decker, Nathalie Brouard, Amer Najjar, Dongxia Xing, Hong Yang, Sufang Li, Frank Marini, Patrick A. Zweidler-McKay, Catherine M. Bollard, Elizabeth J. Shpall, Gianpietro Dotti, Paul J. Simmons. (2009) Noninvasive Bioluminescent Imaging Demonstrates Long-Term Multilineage Engraftment of Ex Vivo-Expanded CD34-Selected Umbilical Cord Blood Cells. Stem Cells 27:8, 1932-1940
    CrossRef

22. 22

    Elizabeth Cerceo, Robert M. Kotloff, Denis Hadjiliadis, Vivek N. Ahya, Alberto Pochettino, Colin Gillespie, Jason D. Christie. (2009) Central Airways Obstruction Due to Aspergillus fumigatus After Lung Transplantation. The Journal of Heart and Lung Transplantation 28:5, 515-519
    CrossRef

23. 23

    Anjali S Advani, Mary J Laughlin. (2009) Umbilical cord blood transplantation for acute myeloid leukemia. Current Opinion in Hematology 16:2, 124-128
    CrossRef

24. 24

    S H Lim, Y Zhang, C Burris, M Townsend. (2008) Successful salvage with unrelated umbilical cord blood transplant for Hodgkin's disease relapsed following autologous stem cell transplant. Bone Marrow Transplantation 42:3, 213-214
    CrossRef

25. 25

    William Tse, Kevin D Bunting, Mary J Laughlin. (2008) New insights into cord blood stem cell transplantation. Current Opinion in Hematology 15:4, 279-284
    CrossRef

26. 26

    M de Lima, J McMannis, A Gee, K Komanduri, D Couriel, B S Andersson, C Hosing, I Khouri, R Jones, R Champlin, S Karandish, T Sadeghi, T Peled, F Grynspan, Y Daniely, A Nagler, E J Shpall. (2008) Transplantation of ex vivo expanded cord blood cells using the copper chelator tetraethylenepentamine: a phase I/II clinical trial. Bone Marrow Transplantation 41:9, 771-778
    CrossRef

27. 27

    Hsiu-Ju Yen, Tzeon-Jye Chiou, Giun-Yi Hung, Chia-Yau Chang, Ming-Yun Hsieh, Cheng-Hwai Tzeng, Po-Min Chen, Ren-Bin Tang. (2008) Long-term mixed full-donor chimerism with dominance reversion after a double-unit cord blood transplant. European Journal of Haematology 80:4, 366-367
    CrossRef

28. 28

    V Bachanova, D Weisdorf. (2008) Unrelated donor allogeneic transplantation for adult acute lymphoblastic leukemia: a review. Bone Marrow Transplantation 41:5, 455-464
    CrossRef

29. 29

    W W Tse, S L Zang, K D Bunting, M J Laughlin. (2008) Umbilical cord blood transplantation in adult myeloid leukemia. Bone Marrow Transplantation 41:5, 465-472
    CrossRef

30. 30

    K. V. Komanduri, L. S. St. John, M. de Lima, J. McMannis, S. Rosinski, I. McNiece, S. G. Bryan, I. Kaur, S. Martin, E. D. Wieder, L. Worth, L. J. N. Cooper, D. Petropoulos, J. J. Molldrem, R. E. Champlin, E. J. Shpall. (2007) Delayed immune reconstitution after cord blood transplantation is characterized by impaired thymopoiesis and late memory T-cell skewing. Blood 110:13, 4543-4551
    CrossRef

31. 31

    C. -A. Rodrigues, V. Rocha, E. Gluckman. (2007) Le point sur la greffe de sang de cordon. Oncologie 9:12, 848-855
    CrossRef

32. 32

    Barbara Novelo-Garza, Alejandro Limon-Flores, Angel Guerra-Marquez, Fernando Luna-Bautista, Luis Juan-Shum, Ines Montero, Elizabeth Sanchez-Valle, Maria Antonieta Vélez-Ruelas, Hector Mayani. (2007) Establishing a cord blood banking and transplantation program in Mexico: a single institution experience. Transfusion 0:0, 071121030748012-???
    CrossRef

33. 33

    Alvaro Urbano-Ispizua. (2007) Risk assessment in haematopoietic stem cell transplantation: Stem cell source. Best Practice & Research Clinical Haematology 20:2, 265-280
    CrossRef

34. 34

    Claudio G Brunstein, K Scott Baker, John E Wagner. (2007) Umbilical cord blood transplantation for myeloid malignancies. Current Opinion in Hematology 14:2, 162-169
    CrossRef

35. 35

    Lakshmanan Krishnamurti. (2007) Hematopoietic cell transplantation for sickle cell disease: state of the art. Expert Opinion on Biological Therapy 7:2, 161-172
    CrossRef

36. 36

    Erik J. Woods, Karen E. Pollok, Michael A. Byers, Brandon C. Perry, Jester Purtteman, Shelly Heimfeld, Dayong Gao. (2007) Cord Blood Stem Cell Cryopreservation. Transfusion Medicine and Hemotherapy 34:4, 276-285
    CrossRef

37. 37

    Young-Ho Lee. (2007) Cord Blood - Current Status and Perspective. The Korean Journal of Hematology 42:3, 181
    CrossRef

38. 38

    N Naeem, A Eyzaguirre, J A Kern, H M Lazarus, R B Hejal, M J Laughlin, E F O Kern. (2006) Outcome of adult umbilical cord blood transplant patients admitted to a medical intensive care unit. Bone Marrow Transplantation 38:11, 733-738
    CrossRef

39. 39

    Takahiro Suzuki, Yasuhisa Yokoyama, Keiki Kumano, Minoko Takanashi, Shiro Kozuma, Tsuyoshi Takato, Tatsutoshi Nakahata, Mitsuo Nishikawa, Seiji Sakano, Mineo Kurokawa, Seishi Ogawa, Shigeru Chiba. (2006) Highly Efficient Ex Vivo Expansion of Human Hematopoietic Stem Cells Using Delta1-Fc Chimeric Protein. Stem Cells 24:11, 2456-2465
    CrossRef

40. 40

    Navneet S. Majhail, Claudio G. Brunstein, John E. Wagner. (2006) Double umbilical cord blood transplantation. Current Opinion in Immunology 18:5, 571-575
    CrossRef

41. 41

    Claudio G. Brunstein, John E. Wagner. (2006) Cord blood transplantation for adults. Vox Sanguinis 91:3, 195-205
    CrossRef

42. 42

    L Lekakis, S Giralt, D Couriel, E J Shpall, C Hosing, I F Khouri, P Anderlini, M Korbling, T Martin, R E Champlin, M de Lima. (2006) Phase II study of unrelated cord blood transplantation for adults with high-risk hematologic malignancies. Bone Marrow Transplantation 38:6, 421-426
    CrossRef

43. 43

    Richard L. Haspel, Karen K. Ballen. (2006) Double cord blood transplants. Stem Cell Reviews 2:2, 81-86
    CrossRef

44. 44

    Pablo Rubinstein. (2006) Why Cord Blood?. Human Immunology 67:6, 398-404
    CrossRef

45. 45

    Eun-Na Lee, Jienny Lee, Eun-Young Kim, Hae-Jung Park, Chi-Young Chang, Da-Yeon Jung, Su-Young Choi, Suk-Koo Lee, Jae-Won Joh, Choon-Hyuck Kwon, Jae-Hyung Noh, Sung-Joo Kim. (2006) Tolerance induction through simultaneous double bone marrow transplantation with two-signal blockade. Immunology Letters 102:2, 215-221
    CrossRef

46. 46

    Claudio G. Brunstein, John E. Wagner. (2006) Umbilical Cord Blood Transplantation and Banking. Annual Review of Medicine 57:1, 403-417
    CrossRef

47. 47

    S N Robinson, J Ng, T Niu, H Yang, J D McMannis, S Karandish, I Kaur, P Fu, M Del Angel, R Messinger, F Flagge, M de Lima, W Decker, D Xing, R Champlin, E J Shpall. (2006) Superior ex vivo cord blood expansion following co-culture with bone marrow-derived mesenchymal stem cells. Bone Marrow Transplantation 37:4, 359-366
    CrossRef

48. 48

    P. Mao, Z. Zhu, H. Wang, S. Wang, W. Mo, Y. Ying, Q. Li, Y. Xu. (2005) Sustained and stable hematopoietic donor-recipient mixed chimerism after unrelated cord blood transplantation for adult patients with severe aplastic anemia. European Journal of Haematology 75:5, 430-435
    CrossRef

49. 49

    William B. Slayton, David A. Wainman, Xiao Miao Li, Zhongbo Hu, Anil Jotwani, Christopher R. Cogle, Danielle Walker, Robert C. Fisher, John R. Wingard, Edward W. Scott, Martha C. Sola. (2005) Developmental Differences in Megakaryocyte Maturation Are Determined by the Microenvironment. Stem Cells 23:9, 1400-1408
    CrossRef

50. 50

    Alma J. Nauta, Alwine B. Kruisselbrink, Ellie Lurvink, Arend Mulder, Frans H. Claas, Willy A. Noort, Roel Willemze, Willem E. Fibbe. (2005) Enhanced engraftment of umbilical cord blood-derived stem cells in NOD/SCID mice by cotransplantation of a second unrelated cord blood unit. Experimental Hematology 33:10, 1249-1256
    CrossRef

51. 51

    Say-Bee Poh, Liang-Tsai Hsiao, Ching-Fen Yang, Tzeon-Jye Chiou, Po-Min Chen. (2005) Fatal Early-Onset Epstein-Barr Virus–Associated Posttransplantation Lymphoproliferative Disease after Successful Adult Dual-Unit Umbilical Cord Blood Transplantation. Biology of Blood and Marrow Transplantation 11:9, 732-733
    CrossRef

52. 52

    Rafael Bornstein, Aan I. Flores, M. Angeles Montalbán, Manuel J. del Rey, Javier de la Serna, Florinda Gilsanz. (2005) A Modified Cord Blood Collection Method Achieves Sufficient Cell Levels for Transplantation in Most Adult Patients. Stem Cells 23:3, 324-334
    CrossRef

53. 53

    He Broxmeyer. (2005) Biology of cord blood cells and future prospects for enhanced clinical benefit. Cytotherapy 7:3, 209-218
    CrossRef

54. 54

    S Robinson, T Niu, M de Lima, J Ng, H Yang, J McMannis, S Karandish, T Sadeghi, P Fu, M del Angel, S O'Connor, R Champlin, E Shpall. (2005) Ex vivo expansion of umbilical cord blood. Cytotherapy 7:3, 243-250
    CrossRef

55. 55

    Vanderson Rocha, Guillermo Sanz, Eliane Gluckman. (2004) Umbilical cord blood transplantation. Current Opinion in Hematology 11:6, 375-385
    CrossRef

56. 56

    John E Wagner, Catherine M Verfaillie. (2004) Ex vivo expansion of umbilical cord blood hemopoietic stem and progenitor cells. Experimental Hematology 32:5, 412-413
    CrossRef

57. 57

    Eliane Gluckman, Vanderson Rocha, William Arcese, Gérard Michel, Guillermo Sanz, Ka-Wah Chan, Tsuneo A Takahashi, Juan Ortega, Alexandra Filipovich, Franco Locatelli, Shigetaka Asano, Franca Fagioli, Marcus Vowels, Anne Sirvent, Jean-Philippe Laporte, Karin Tiedemann, Sergio Amadori, Manuel Abecassis, Pierre Bordigoni, Blanca Diez, Peter J Shaw, Ajay Vora, Maurizio Caniglia, Federico Garnier, Irina Ionescu, Joan Garcia, Gesine Koegler, Paolo Rebulla, Sylvie Chevret, on behalf of the Eurocord Group. (2004) Factors associated with outcomes of unrelated cord blood transplant: Guidelines for donor choice. Experimental Hematology 32:4, 397-407
    CrossRef

58. 58

    Ryuji Nakagawa, Tsutomu Watanabe, Yoshifumi Kawano, Sachiyo Kanai, Hiroko Suzuya, Michiya Kaneko, Hiroyoshi Watanabe, Yasuhiro Okamoto, Yasuhiro Kuroda, Takayoshi Nakayama, . (2004) Analysis of maternal and neonatal factors that influence the nucleated and CD34+ cell yield for cord blood banking. Transfusion 44:2, 262-267
    CrossRef

59. 59

    Liang-Piu Koh, Nelson J Chao. (2004) Umbilical cord blood transplantation in adults using myeloablative and nonmyeloablative preparative regimens. Biology of Blood and Marrow Transplantation 10:1, 1-22
    CrossRef

60. 60

    Manuel N Fernández, Carmen Regidor, Rafael Cabrera, José A Garcı́a-Marco, Rafael Forés, Isabel Sanjuán, Jorge Gayoso, Santiago Gil, Elena Ruı́z, Ann-Margaret Little, Alasdair McWhinnie, Alejandro Madrigal. (2003) Unrelated umbilical cord blood transplants in adults: Early recoveryof neutrophils by supportive co-transplantation of a low number of highlypurified peripheral blood CD34+ cells from an HLA-haploidentical donor. Experimental Hematology 31:6, 535-544
    CrossRef

61. 61

    Keiichi Isoyama, Kei Ohnuma, Koichiro Ikuta, Yasunori Toyoda, Fumiaki Nakajima, Kouichiro Yamada, Hirokazu Nishihira, . (2003) Unrelated cord blood transplantation for second hemopoietic stem cell transplantation. Pediatrics International 45:3, 268-274
    CrossRef

62. 62

    Giuseppe Bandini, Francesca Bonifazi, Michele Baccarani. (2003) 15 or 33 years of cord-blood transplantation?. The Lancet 361:9368, 1566-1567
    CrossRef

63. 63

    Guillermo F. Sanz, Vanderson Rocha. (2003) Umbilical cord blood transplantation: current status and future directions. Current Opinion in Organ Transplantation 8:1, 109-117
    CrossRef

64. 64

    C.A. Rusinko, D.A. Sesok-Pizzini. (2003) Using a technological community framework to manage new medical technologies: The case of umbilical cord blood (UCB) banking. Journal of Health Organisation and Management 17:6, 399-421
    CrossRef

65. 65

    Keiichi Isoyama, Kei Ohnuma, Koji kato, Tsuneo A. Takahashi, Shunro Kai, Shun-ichi Kato, Minoko Takanashi, Norihiro Sato, Hiroyuki Sato, Kohichi Kitajima, Tomoki Naoe, Hidehiko Saito, Hirokazu Nishihira. (2003) Cord Blood Transplantation from Unrelated Donors: A Preliminary Report from the Japanese Cord Blood Bank Network. Leukemia & Lymphoma 44:3, 429-438
    CrossRef

66. 66

    I. D. Lewis. (2002) Clinical and experimental uses of umbilical cord blood. Internal Medicine Journal 32:12, 601-609
    CrossRef

67. 67

    Marcos de Lima, Lisa S. St. John, Eric D. Wieder, Ming S. Lee, John McMannis, Safa Karandish, Sergio Giralt, Miroslav Beran, Daniel Couriel, Martin Korbling, Samer Bibawi, Richard Champlin, Krishna V. Komanduri. (2002) Double-chimaerism after transplantation of two human leucocyte antigen mismatched, unrelated cord blood units. British Journal of Haematology 119:3, 773-776
    CrossRef

68. 68

    Marcos de Lima, Elizabeth J. Shpall. (2002) Cord blood transplantation. Current Opinion in Organ Transplantation 7:3, 286-293
    CrossRef

69. 69

    Richard C. Meagher, Hans G. Klingemann. (2002) Human Umbilical Cord Blood Cells: How Useful Are They for the Clinician?. Journal of Hematotherapy <html_ent glyph="@amp;" ascii="&"/> Stem Cell Research 11:3, 445-448
    CrossRef

70. 70

    Juliet N. Barker, John E. Wagner. (2002) Umbilical cord blood transplantation: current state of the art. Current Opinion in Oncology 14:2, 160-164
    CrossRef