HJAR Mar/Apr 2025

46 MAR / APR 2025 I  HEALTHCARE JOURNAL OF ARKANSAS ADH CORNER COLUMN CHILDREN’S HEALTH AS the indications for hematopoietic cell transplants (HCT) continue to expand, the demand for hematopoietic stem cell (HSC) donors has surged. Akey challenge in HCT remains the difficulty in finding a suitable donor. As the probability of find- ing a fully matched sibling donor is only 20%, most patients depend on alterna- tive donor sources. Over 40 million indi- viduals are registered with the National Marrow Donor Program (NMDP) and its affiliated registries. However, many pa- tients, particularly those from minority and ethnically diverse groups, face sig- nificant challenges in finding an appro- priately matched unrelated donor within the critical timeframe. Recently, haploidenti- cal (half-matched) HCTs, using donors such as parents, children or siblings who share at least 50% of their human leukocyte antigen (HLA) genes with the patient, have emerged as a viable option. However, higher rates of graft-versus-host disease (GVHD) and de- layed immune recovery, which increases susceptibility to infections, hinder this ap- proach. Furthermore, concerns have been raised about the quality of stem cells from older donors (aged over 35), especially re- garding acquired genetic mutations known as clonal hematopoiesis of indeterminate potential (CHIP), which could potentially complicate the success of the HCT. Once considered waste, umbilical cord blood (UCB) collected from the umbilical vein at birth is a rich source of CD34+ HSCs and progenitor cells, capable of self-renewal, proliferation and full engraftment to form new blood cells and an immune system in the recipient. Umbilical cord blood trans- plant (UCBT) has emerged as a highly effec- tive alternative source of HSCs, significantly expanding transplant eligibility for patients of racial and ethnic minorities across the U.S. and globally. Since the first UCB HCT in 1988 for a pa- tient in France with Fanconi anemia, over 40,000 UCB HCTs have been performed, with more than half of these patients achieving a FROM WASTE TO WONDER: Harnessing the Power of Umbilical Cord Blood