Cord blood transplants use newborn umbilical cord blood stem cells to treat blood cancers and inherited blood disorders. They require less strict HLA matching than bone marrow, but a single cord unit has fewer stem cells, which can slow engraftment. Strategies such as double-unit transplants and lab expansion increase cell dose and have extended cord blood use to larger patients. Public cord banks supply most therapeutic units; private banking stores cord blood for family use. Discuss options with a transplant center to determine the best graft source.
Why cord blood matters
Umbilical cord blood contains hematopoietic (blood-forming) stem cells that can replace damaged bone marrow. Since the first clinical uses in the late 1980s, cord blood transplants have become an accepted treatment for leukemia, other blood cancers, and several inherited blood disorders. They are an alternative to bone marrow or peripheral blood stem cell transplants, especially when a matched donor is hard to find.
Advantages and limitations
Cord blood has two practical advantages: units are rapidly available from public banks, and the required match between donor and recipient HLA markers can be less strict than for bone marrow. That relaxed matching often increases access for patients who have trouble finding a fully matched adult donor.
The main limitation is cell dose. A single cord blood unit contains fewer stem cells than a typical adult donor graft, so engraftment (the time it takes for transplanted cells to start producing blood) is usually slower. Slower engraftment raises early infection risk and lengthens recovery time after transplant. On the plus side, cord blood transplants tend to cause less severe chronic graft-versus-host disease (GVHD) for comparable disease control.
How clinicians address low cell dose
To overcome low cell numbers, transplant teams use several strategies. For adults, clinics may give two cord blood units (a "double" transplant) to increase the stem-cell dose. Researchers also use ex vivo expansion methods to multiply cells from a single unit in the laboratory before infusion. These approaches have expanded the use of cord blood in larger adolescent and adult patients and continue to appear in clinical studies.
Public and private banking
Parents can choose public donation or private storage for a newborn's cord blood. Public banks accept donations for use by anyone who matches and typically do not charge donors. Private (family) banks store cord blood exclusively for personal use and charge collection and annual storage fees. Most therapeutic cord-blood transplants use public-bank donations or unrelated donor units identified through registries.
Who should consider cord blood transplantation?
Cord blood is a treatment option for many patients with blood cancers, bone marrow failure syndromes, and certain genetic blood disorders. If a bone marrow transplant is recommended, discuss cord blood with your transplant physician or a transplant center. They will evaluate disease type, patient size, HLA match, and cell dose to determine whether cord blood, bone marrow, or peripheral blood stem cells are the best option.
The bottom line
Cord blood remains a valuable and evolving resource for hematopoietic stem cell transplantation. Advances in cell-dose strategies have increased its use in adults while preserving its early advantages in availability and reduced chronic GVHD. Talk with a transplant specialist or your hematologist for personalized guidance.
How does cord blood compare to bone marrow transplants?
Cord blood is easier to match in many cases and is often available faster from public banks. However, a cord blood unit has fewer stem cells than a typical adult donor graft, so engraftment can be slower and early recovery may take longer.
Can adults receive cord blood transplants?
Yes. Strategies such as using two cord blood units or expanding cells in the lab have made cord blood transplants feasible for many adults, though center experience and patient size affect suitability.
Should I store my baby’s cord blood privately?
Private storage is an option if you want a family reserve, but it involves upfront and ongoing fees and has limited likelihood of use. Many therapeutic transplants use public-bank units; consider public donation if you want to help others.
Are cord blood transplants safer in terms of graft-versus-host disease (GVHD)?
Cord blood transplants are generally associated with lower rates or milder forms of chronic GVHD compared with unrelated adult donor grafts, while still providing effective anti-cancer effects in many settings.