Transplant Cell Ther. 2026 Nov 13. pii: S2666-6367(26)00896-1. [Epub ahead of print]
American Society for Transplantation and Cellular Therapy Cord Blood Special Interest Group
The introduction and wide adoption of post-transplant cyclophosphamide-based graft-versus host disease (GVHD) prophylaxis has changed the landscape of allograft donor selection such that allograft candidates now commonly have multiple potential graft sources, and there can be uncertainty over which graft source to prioritize. This position statement, written by the American Society for Transplantation and Cellular Therapy Cord Blood (CB) Special Interest Group and leading CB transplant physicians in the United States and abroad, discusses the state-of-the-art in CB transplantation (CBT). We highlight recent outcome data from multiple domestic and international centers with CBT expertise, across both adult and pediatric settings. Applying these data, we outline 4 clinical scenarios where CB may be the graft of choice: patients who lack a suitable, young, readily available donor, those in need of urgent transplantation, patients with difficult-to-cure acute leukemia or myelodysplastic syndrome, and patients with non-malignant diseases. We also present potential mechanisms underlying the unique graft-versus-leukemia effects mediating reduced relapse following CBT, along with the advantages of reduced chronic GVHD. This position statement emphasizes the critical, ongoing role of CBT in the transplant field, and will help guide transplant physicians to consider CBT as a preferred donor (or, as needed, referral to a center with CBT expertise) for patients in these scenarios.
Keywords: Allogeneic transplantation; Cord blood; Donor selection; alternative donor; graft choice; graft source