I had the honor of interviewing Dr. Filippo Milano, Associate Director of Cord Blood Transplantation at the Fred Hutchinson Cancer Research Centre about cord blood transplantation. In this interview, Dr. Milano speaks about trends in cord blood transplantation (CBT) that are affecting the global cord blood industry.
Interview with Dr. Filippo Milano
Cade Hildreth: What are recent achievements with cord blood transplantation?
Dr. Filippo Milano: The biggest achievements in the field of cord blood transplantation (CBT) are represented by increased utilization of ex vivo systems of expansion of stem cell progenitors. Different clinical trials have been conducted and preliminary results show uniformly reduction of time to ANC engraftment and improvement in the rate of graft failure.
Cade Hildreth: How do you see cord blood transplantation changing in the next 5 years?
Dr. Filippo Milano: This is a tough question. The number of cord blood transplants is decreasing both in the USA and within Europe. This is due mainly to the increased utilization of haploidentical transplants that are easier to perform and cheaper than cord blood transplantation. For the cord blood transplantation field to progress over the next 5 years, we need to focus our work on decreasing the cost of cord blood units and creating a uniform approach to cord blood transplantation.
Cade Hildreth: What is the biggest challenge facing cord blood transplantation?
Dr. Filippo Milano: As I mentioned, cost is definitely a big issue at this moment for the cord blood transplantation field. Another challenge is represented by the fact that cord blood transplantation is the last transplant option in many transplant centres. Only a few transplant centres perform more than 5-10 cord blood transplantations per year, so they do not acquire enough expertise to perform cord blood transplantation more successfully.
We need greater utilization of cord blood, as well as greater proficiency with cord blood transplantation procedures across more transplant centers.
Cade Hildreth: What progress or achievements are you seeing with cord blood transplantation?
Dr. Filippo Milano: Although the number of cord blood transplantations is decreasing, the outcomes of cord blood transplantation at our institution are extremely encouraging, with very low rate of relapse compared to the ones after matched or mismatched unrelated transplants. Furthermore, with the use of ex vivo expanded cells, we have observed a significant reduction of transplant related mortality after myeloablative cord blood transplantation.
Cade Hildreth: What is your area of expertise as it relates to cord blood transplantation?
Dr. Filippo Milano: My research is focused on clinical practice improvements within umbilical cord blood transplantation, because my goal is to increase the number of patients eligible to be recipients and to improve clinical outcomes for patients undergoing cord blood transplantation. My current studies include:
- Outcomes after cord blood transplantation compared to unrelated donor transplants in patients with hematological malignancies
- Use of a non HLA-matched off-the-shelf ex vivo expanded cord blood progenitor cell product following myeloablative cord blood transplantation
I believe that novel treatments will have the potential to improve patient outcomes, so I am enthusiast to explore potential solutions to improve the cord blood transplantation field.
What challenges and opportunities do you see for cord blood banking? Comment below.