How to cite this article: Peñaflor-Juárez K, Guillén-Chan SM, Romero-Juárez Y, Luna-Bautista F, Franco-Gutiérrez E, Arellano-Ocampo JS, Ibáñez-Sánchez R, Domínguez-Contreras Mde L, Guerra-Márquez A. The cord blood bank at the Instituto Mexicano del Seguro Social. Rev Med Inst Mex Seguro Soc. 2015;53 Supl 1:S94-9.
Received: October 22nd 2014
Accepted: March 6th 2015
Karina Peñaflor-Juárez,a Sonia Marilyn Guillén-Chan,a Yanín Romero-Juárez, Fernando Luna-Bautista,a Elizabeth Franco-Gutiérrez,a Jesús Salvador Arellano-Ocampo,a Rocío Ibáñez-Sánchez,a María de Lourdes Domínguez-Contreras,a Angel Guerra-Márqueza
aBanco Central de Sangre, Hospital de Especialidades, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Distrito Federal, México
Communication with: Angel Guerra-Márquez
Telephone: (55) 5724 5900, extensión 24203
Background: Hematopoietic stem cells have been used for over 50 years in the treatment of diverse diseases. Umbilical cord blood (UCB) has proved to be a viable source of hematopoietic stem cells for transplantation purposes. The aim was to report the contribution of the umbilical cord blood bank over the past 9 years, in the treatment of various diseases.
Methods: Since 2005 the number of units of blood from the umbilical cord and their use for transplantation in diverse disease were analyzed. A selection of volunteer pregnant women in labor was performed. Umbilical cord blood was obtained from them, which underwent processing, cryopreservation and validation, as well as compatibility test before using for transplantation.
Results: Ten thousand and ninety nine candidates to donation were assessed, from whom 2481 unit of UCB were collected. Of these, 893 unit were processed and cryopreserved for transplantation. In 65 % of cases there was histocompatibility between the cord cell and the receptors. Transplantation was done in 87 patients, 67 % had hematologic neoplasias, who have received 140 units of UCB in 102 transplants. This Bank of UCB ranks second in the world in productivity according to the rate of utility of units in transplantation (3.3 %).
Conclusions: Our bank of UCB has been able to develop a cell line (hematopoietic stem cells) with international quality standards and has been beneficial for patients served by our institution with need of a transplant mainly in hemato-oncologic patients.
Keywords: Cord blood banking, Transplantation, Hematopoietic stem cells.
Hematopoietic stem cells (HSC) have been used in transplants to treat a number of diseases, primarily hematologic, for over 50 years.1 The original source to obtain it was bone marrow and subsequently mobilized peripheral blood. Since the 80’s of the last century it has been seen that cord blood is a rich source of HSC and could be an alternative to bone marrow.2 The first successful transplant using umbilical cord blood was performed by Elianne Gluckman in Paris in 1988.3 Unlike HSC from bone marrow or mobilized peripheral blood, HSC collection from umbilical cord blood has no risk for the donor and it gives therapeutic use to a product that is considered a biological waste. Cord blood banks (CBB), both public and private, have been established worldwide. The first public CBB was established in 1993 by Rubinstein in New York.4
HSC from cord blood has advantages over those obtained from bone marrow or mobilized peripheral blood: they are less alloreactive, so full compatibility with the receiver is not required; they have a lower risk of transmission of infectious agents; and they are immediately available for clinical use.5
Allogeneic transplant of HSC is the treatment of choice for a great variety of hematologic diseases, immunodeficiency, and innate errors of metabolism, but it requires having a donor compatible with the recipient, ideally in their immediate family. Only 25-30% of patients have a related matched donor, so the CCB have become a viable alternative to supply compatible units.
Epidemiological reports of the IMSS insured population show that acute leukemia ranks first or second in morbidity and mortality in the pediatric population. Particularly in patients with high-risk leukemia, HSC transplantation is a viable therapeutic alternative when they have a compatible donor in their family. For those who do not have a related matched donor there is need for an unrelated donor of mobilized peripheral blood or umbilical cord blood, so the project of developing an institutional CBB was established in 2002.
CBB institutional headquarters was assigned to the Central Blood Bank of Centro Médico Nacional La Raza as the Institute's largest and most productive blood bank; it gathers 14.16% of the blood that is collected at IMSS and 5.5% of that of the country, and also because it has a physical area in its new building opened in 2002. The integration program included, apart from the designation of a physical area, defining processes, implementing a Quality Management System, and the selection and training of personnel and equipment. The aim of this paper is to present the experience of the CBB at Instituto Mexicano del Seguro Social 9 years after its creation.
This study was conducted at the Banco de Sangre of the Centro Médico Nacional La Raza during the period from 2005 to July 2014. It describes the following:
|Table I Evaluation of umbilical cord blood units.Tests carried out on maternal and umbilical cord samples to determine their availability for transplantation|
|Maternal samples||Umbilical cord blood units|
|Typing of blood group ABO and Rh(D)||Typing of blood group ABO and Rh(D)|
|Infectious serology (Hepatitis B, Hepatitis C, Human
immunodeficiency virus, Treponemal antibodies,
|Infectious serology (Hepatitis B, Hepatitis C, Human
immunodeficiency virus, Treponemal antibodies,
Trypanosoma cruzi antibodies, Cytomegalovirus viral load2)
|Complete blood cytometry||Complete blood cytometry|
|Determination of irregular antibodies||Determination of CD34+ cells3|
|Microbiological culture (aerobic, anaerobic, fungi, mycobacteria)|
|1Using chemiluminescence and determination of viral nucleic acid (VNA)
2Using chemiluminescence, VNA, and PCR
3Using flow cytometry
4In semi-solid medium
5Using molecular biology: locus A and B medium resolution, locus DRB1 high resolution
6Using trypan blue exclusion method
From February 2005 to July 2014 10,099 potential donors were evaluated, 24.56% completed the donation, and 36% of the collected units were cryopreserved (Table II). Of all potential donors only 893 units (8.84%) were cryopreserved, which means that to have one unit of cord blood available for transplant, it is necessary to assess just over twelve potential donors and also to collect three units of umbilical cord blood in order to have one available for transplant.
|Table II Donors assessed, units collected and cryo-preserved from February 2005 to July 2014.|
From February 2005 to July 2014, 689 search requests for HLA-compatible units were received from eight institutional transplant centers. Positive response (at least one compatible unit) was given in 65% of cases, with variations according to geographic region: 81% response for transplant centers located in Puebla and Mexico City, and only 59% for Monterrey and Torreon. 140 umbilical cord blood units have been transplanted in 87 patients with a total of 102 transplants. Transplant centers of the Institute that have transplanted cord blood units are shown in Table III, and the conditions for which they have been used in Table IV. Significantly, two-thirds of the units have been used to transplant patients with hematologic malignancies, and of these 75% were acute lymphoblastic leukemia (ALL).
|Table III Institutional transplant centers that have transplanted umbilical cord blood units|
|UMAE Manuel Ávila Camacho Puebla|
|Hospital General Centro Médico Nacional La Raza|
|Hospital Pediatría Centro Médico Nacional SXXI|
|Hospital de Especialidades Centro Médico Nacional SXXI|
|Hospital de Especialidades Centro Médico Nacional La Raza|
|UMAE Hospital de Especialidades 25 Monterrey|
|Hospital Regional General No. 1 "Dr. Carlos MacGregor Sánchez Navarro"|
|Table IV Pathologies for which umbilical cord blood units have been used and their percentages|
|Hematologic malignancies (66.7%):|
|Acute lymphoblastic leukemia, acute myeloid leukemia, chronic granulocytic leukemia|
|Medullary Aplasia (17.8%):|
|Severe aplastic anemia, Fanconi's anemia, Wiskott-Aldrich Syndrome|
|Congenital immunodeficiencies (6.4%):|
|Griscelli syndrome, congenital neutropenia, severe combined immunodeficiency|
|Innate errors of metabolism/storage diseases (4.9%):|
Three articles have been published in national journals6-8 and two in international publications,9,10 as well as being worthy of an editorial because of the paper published in the journal Transfusion in 2008.11 In 2011 a global overview was published of the organization and operation of CBB programs in a select group of developing countries (according to the Human Development Index of the United Nations) with emerging economies, representing regions designated by the World Health Organization. Mexico was selected as representative of the region of the Americas, together with Brazil,12 mention being made of the Institution’s CBB.
In December 2006 the ISO-9001-2000 certification was obtained and in December 2012 the ISO-9001-2008 system was updated and remains valid.
By 2012, the institution’s CBB ranked second in the world in productivity, considering the utilization rate of transplant units (3.342%), surpassed only by the consortium of Japanese umbilical cord blood banks (3.908%)13 (Table V).
|Table V Percentage of umbilical cord blood units provided for transplantation in relation to number of stored units|
|Umbilical cord blood units|
|Japan JCBBN||1 175||30,063||3.908|
|Mexico La Raza||25||748||3.342|
|Mexico CNTS||39||1 555||2.508|
|USA-NMDP Network||1 870||185,484||1.008|
|* CNTS- Centro Nacional para la Transfusión Sanguínea. (National Center for Blood Transfusion).|
The CBB of the Instituto Mexicano del Seguro Social has developed a (hematopoietic stem) cell line with international quality standards, and their experience is comparable to that reported by other banks qualified as world-class.14-18 This has been possible thanks the implementation of a Quality Management System in the CBB, the validation process prior to its implementation, the focus on quality rather than quantity, the monitoring of indicators, continuous improvement, and the experience and productivity of institutional transplant centers.
The CBB can be considered as a mature organization that has benefitted patients in need of a transplant. However, the future of CBB is in the development of new cell lines that can be used therapeutically: dendritic cells, mesenchymal cells, and platelet factors. This type of cells, in addition to the HSC, appear to have a significant impact on the treatment of various disorders, in therapeutic modalities known as cell therapy and regenerative medicine,19 without its usefulness in clinical practice currently having been fully demonstrated. However, we must consider the evolution of CBB as biotechnology entities.
The CBB of the Instituto Mexicano del Seguro Social has developed a (hematopoietic stem) cell line with international quality standards that has been used in patients in need of transplant.
Conflict of interest statement: The authors have completed and submitted the form translated into Spanish for the declaration of potential conflicts of interest of the International Committee of Medical Journal Editors, and none were reported in relation to this article.