A proposal for improvement in the utilization rate of banked cord blood

which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Cord blood (CB) has been used as an alternative source for unrelated stem cell transplantation (SCT) for patients with hematologic malignances, bone marrow failure syndromes , and immune deficiencies. Since the first patient (a child with Fanconi anemia) was successfully treated with CB transplantation (CBT) in 1988, over 20,000 patients worldwide have received unrelated CBT. In Korea, approximately 500 patients have received unrelated CBT since its first successful use in a patient with acute leukemia in 1998 [1]. Disadvantages of the treatment, such as limited cell doses, slow engraftment, and a high rate of graft failure, were major obstacles in the early CBT era, although several advantages over conventional bone marrow transplantation (BMT) and peripheral blood stem cell (PBSC) transplantation (PBSCT) have been reported. However, the findings from many clinical trials and primary research studies have led to substantial improvement in the availability and outcomes of CBT. Most recent studies of unrelated CBT have shown outcomes comparable to those of unrelated BMT or PBSCT [2, 3]. Therefore, CB is no longer just an alternative source for unrelated SCT; furthermore, unrelated donors for SCT have to be selected according to patient status because there are advantages and disadvantages associated with different stem cell sources. Although the clinical availability of CB has been expanded , and because it is expected to be a good source for unrelated SCT, several problems need to be solved before the utilization of banked CB can be increased, and before it can become a good option for physicians who have to select optimal unrelated stem cell donors. Recently, the CB Committee of the Korean Society of Blood & Marrow Transplantation conducted an on-site questionnaire study targeting transplant physicians and nurses to determine the current problems associated with the low utilization rate of banked CB. On the basis of this ongoing study, I would like to present a proposal for improving the utilization rate of banked CB. First, it is essential to manage the quality of banked CB and to gain transplant physicians' trust in its use. Although most CB banks have their own standard operating procedure based on international standards, all CB banks should undergo scheduled inspections from an international organization such as the Foundation for the Accreditation of Hematopoietic Cell Therapy or a national organization according to the …