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HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2025 47 Smitha Hosahalli Vasanna, MD Pediatric Hematologist-Oncologist Arkansas Children’s for successful engraftment in adults, exac- erbated by the size discrepancy. However, recent innovations, such as double cord blood — combining two cord blood units — and ex vivo expansion techniques utilizing nicotinamide, have significantly broadened the use of UCBT in adults, ensuring sufficient stem cell doses for effective transplantation. Some of UCB’s disadvantages include slower engraftment of neutrophils and platelets and overall immune recovery. In recent decades, significant strides have been made to address these limitations, such as ex vivo expansion with mesenchymal cell coculture and stem cell fucosylation. A crucial consideration for expectant parents is whether to bank their newborn’s UCB and, if so, whether to utilize a public or private cord blood bank. Public donation through registries like “Be the Match” is a cost-free option for healthy, full-term births. Donated cord blood supports life-saving transplants and research but precludes per- sonal use. Conversely, private cord blood banking entails storing the child’s cord blood privately for a fee. It is imperative to note that cord blood cannot treat genetic condi- tions or malignancies in the same individual, as it harbors identical genetic mutations or pre-malignant cells. Private banking offers potential benefits solely if a family mem- ber requires HCT for an eligible condition, contingent on the donor being unaffected. A “savior sibling” is a child conceived through in vitro fertilization (IVF) to be an HLAmatch for an existing sibling who needs an HCTwithout inheriting the sibling’s med- ical condition. The ethical considerations surrounding savior siblings are complex, involving a delicate balance between the potential to save a life and the rights and welfare of the savior sibling. While this prac- tice offers substantial medical benefits, it also raises important ethical questions that must be carefully evaluated by both families and medical professionals. The applications of UCB have rapidly expanded beyond traditional UCBT. UCB- derived, virus-specific T cells have dem- onstrated efficacy in treating adenovirus, cytomegalovirus, and Epstein-Barr virus infections. Moreover, anti-CD19 chimeric antigen receptor (CAR) natural killer (NK) cells derived from UCB have been utilized to treat B-cell malignancies, exhibiting fa- vorable tolerability without complete HLA matching. Beyond hematologic and viral applications, UCB holds promise in regen- erative medicine, with ongoing research exploring its therapeutic potential in con- ditions such as cerebral palsy, autism, type 1 diabetes, spinal cord injury, heart failure, Alzheimer’s disease, and cardiovascular diseases, highlighting its versatile role in advancing medical treatments. In conclusion, the transformative journey frommedical waste to therapeutic wonder underscores the remarkable potential of UCB. While its full capabilities remain un- der investigation, ongoing research carries immense promise for the future. n REFERENCES 1 Sanchez-Petitto, G.; Rezvani, K.; Daher, M.; et al. “Umbilical Cord Blood Transplantation: Connect- ing Its Origin to Its Future.” Stem Cells Transla- tional Medicine 12, Issue 2 (February 2023): 55–71. https://doi.org/10.1093/stcltm/szac086 2 Gupta, A.O.; Wagner, J.E. “Umbilical Cord Blood Transplants: Current Status and Evolving Thera- pies.” Frontiers in Pediatrics 8, Oct. 2, 2020: 570282. DOI: 10.3389/fped.2020.570282 3 Martin PL, Kurtzberg J, Hesse B. “Umbilical cord blood: a guide for primary care physicians.” Ameri- can Family Physician 84, no. 6 (Sep. 15, 2011): 661-6. PMID: 21916391 Smitha Hosahalli Vasanna, MD, is a pediatric blood, marrow, and cellular therapy physician at Arkansas Children’s Hospital and an assistant professor of he- matology/oncology in the department of pediatrics at the University of Arkansas for Medical Sciences. cure. Over 800,000 public cord blood banks and over 4 million private cord blood banks, storing approximately 5 million cord blood units, exist worldwide. UCB can be cryopre- served for over 20 years under appropriate conditions, ensuring efficient recovery of vi- able stem cells. The NMDP and the Founda- tion for theAccreditation of CellularTherapy (FACT) provide regulatory guidelines for col- lecting, processing and storing these cord blood units. Ethically, there is no harm to donors, as cord blood would otherwise be discarded. UCBT offers several advantages over bone marrow (BM) and peripheral blood progenitor cells (PBPCs), including easy collection, less stringent HLA-matching criteria, and rapid availability — as short as two weeks, compared to the four to 12 weeks required for other donor sources. This makes UCBT an attractive option for urgent cases such as high-risk leukemia and rapidly progressive inherited metabolic diseases like Krabbe disease and Hurler syndrome. The HSCs in the UCB exhibit higher ex- pression of CD34+ antigen and possess lon- ger telomeres, which enhance their prolif- erative potential and ability to home to the bone marrow. A fully matched human leu- kocyte antigen (HLA) donor is defined as an 8/8 antigen match, a stringent criterion for BM and PBPC grafts, as increasing mis- matches elevate the risk of GVHD. However, due to the naive state of immune cells in UCB, the matching criteria are less stringent, with a lower incidence of GVHD. UCBT has traditionally been more prev- alent in pediatric HCTs due to the limited stem cell dose available, more suitable for the smaller body size of pediatric patients. In contrast, its application in adult HCTs has been more constrained, primarily be- cause of the higher stem cell dose required