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• W2999915569 abstract "Umbilical cord blood has several advantages including immediate availability, no risk to donors and a lower risk of acute and chronic graft-versus-host disease despite major Human Leukocyte Antigen (HLA) disparity. Umbilical cord blood transplantation (CBT) from unrelated donors has been used increasingly as an alternative stem cell source for patients without HLA-compatible related or unrelated donors. Although the incidence of cord blood freezing bag breaks is low, it is a known risk in CBT. We report herein a case of major cord blood freezing bag breakage that occurred when opening the cord blood unit freezing canister on the scheduled day of CBT. The patient was a 49-year-old Japanese male who was diagnosed with Philadelphia chromosome-positive acute lymphoblastic leukaemia in September 2018. After several courses of therapy, he achieved complete remission. Since no related or unrelated bone marrow donors were available, unrelated CBT was planned. A cord blood unit, which contained 5.30 × 107/kg total nucleated cells and 1.23 × 105/kg CD34-positive cells with two locus mismatches in HLA-DRB1, arrived at our hospital from a Japanese public cord blood bank-A (CBB-A) in April 2019. On arrival, the cord blood unit was inspected for damage and no breakage was found before placement into the liquid nitrogen tank (the liquid phase at our hospital). The conditioning regimen included six fractionated 12 Gray total body irradiations, etoposide (30 mg/kg), and cyclophosphamide (120 mg/kg). On the scheduled day of CBT in June 2019, the cord blood unit was removed from the tank and again visually inspected for breakage. When opening the freezing canister, the cord blood bag inflated and then breakage of the large compartment of cord blood unit occurred (Figure 1). As the bag was severely damaged, we decided not to use the cord blood unit for transplantation. Fortunately, another cord blood unit, which contained 2.77 × 107/kg total nucleated cells and 0.69 × 105/kg CD34-positive cells with one locus mismatch in HLA-DRB1 was readily available from CBB-A. The patient received CBT three days after the scheduled day. Graft-versus-host disease prophylaxis consisted of tacrolimus and short-term methotrexate. An absolute neutrophil count >0.5 × 109/l was achieved on day 19. During the follow-up period, the patient was alive and free of disease. In 2014, the results of a nationwide survey on cord blood freezing bag breakage in Japan were reported. In all, 3836 cases of CBT from all public CBBs in Japan were performed during the survey period and 16 breakages (0.4%) were confirmed at transplant centres. Since most of the breakages were considered minor, all 16 units were used for transplantation. In our hospital, 110 single-unit CBTs were performed between October 2000 and April 2019. During this period, no cord blood bag breakages occurred. Although the cause of cord blood bag breakage in our case was unknown, there are a variety of possibilities including failure of the cord blood bag seam, imperfect adhesion of the tube end and a pinhole by external force during transport. Since the cord blood unit was stored in liquid phase nitrogen at our hospital, infiltration of liquid nitrogen after placement into the liquid nitrogen tank may have been followed by the vaporization of infiltrated liquid nitrogen and inflation of the bag after removal from the tank. Vapour phase storage, which is recommended by the CBB, may reduce recurrence of this event." @default.
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• W2999915569 date "2020-01-13" @default.
• W2999915569 modified "2023-09-27" @default.
• W2999915569 title "A major break of cord blood bag" @default.
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• W2999915569 doi "https://doi.org/10.1111/bjh.16313" @default.
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