Celebrating five years of the Cord Support Programme

Cord blood provides an important graft source, especially for patients with limited adult donor options and those with particularly resistant leukaemia. Complexity of the clinical course and patient management in Umbilical Cord Blood Transplantation (UCBT) can make utilisation of this frozen product technically difficult. UCBT only accounts for around 10% of Haematopoietic Stem Cell Transplantations (HSCTs) globally, so maintaining expertise in the area can be challenging.

Anthony Nolan and NHSBT created the Cord Support Programme (CSP) to assist Transplant Centres (TCs) in all aspects of Cord Blood Unit (CBU) usage for transplant, helping to ensure patients have access to the appropriate graft when needed. This year, the programme officially celebrates its fifth birthday! Here we reflect on the incredible milestones and achievements of the CSP over the last half decade – and look ahead to the exciting plans for the next five.

The CSP officially began back in October 2018, after extensive background work and several pilot projects. Throughout 2017 and early 2018 we piloted two of our major CSP services: the CBU Shortlists and CBU Report Quality Checklists. Multiple UK TCs contributed to these pilots and helped us to launch CSP, and we are especially grateful to Leeds and GOSH clinical teams who were with us from the very beginning. The goal of these services was to support TCs in selecting, analysing, and utilising CBUs as a graft source, and we have certainly come a long way towards achieving this goal!

Since those early days, the programme has grown in popularity and interest has increased, with lots of positive feedback from our customers. We’ve had many more TCs sign up for CSP services including Oxford, Hammersmith St Mary’s, Addenbrookes (Cambridge), Glasgow, Birmingham, St Barts, and the London Clinic. We hope to continue to expand our support to all TCs who could benefit from it. In fact, an exciting milestone was achieved earlier this year when the Irish Registry were onboarded as our first international CSP customer!

We now provide a wider variety of services beyond our Shortlists and Checklists, helping to support TCs from bank to bedside.

First, we assist with Search and Selection of CBUs (aka a Shortlist). Using the WMDA Search and Match service, we complete a search for suitable CBUs for a patient based on a variety of parameters, including patient age, weight, and diagnosis. We generate a list of up to 10 of the best units available summarising the key information for each CBU, and the TC can then use this list to assist with their clinical decision making and choose which units they would like to request a full report on.

Once a full report has been received for a CBU, we provide the Cord Blood Unit Report Quality Checklist (aka a Checklist). The Checklist highlights essential and useful information provided on the CBU reports to the TC. Using the current BSHI guidelines, HTA regulations and FACT-Netcord standards, the Checklist highlights missing or alarming information which we bring to the attention of the TC to aid clinical decision making. This also means we can follow-up with the Cord Blood Bank (CBB) for any missing information early in the selection process. The Checklist standardises the information provided on CBU reports from the different CBBs so that it’s easier to compare different units and establish the best option for their patients.

Following on from the Checklists, TCs can request further testing on any CBUs they’re particularly interested in and want to proceed with. Once a CBU has been requested by a TC for further testing or shipment, a small sample of the cord blood, known as a 'segment', is thawed. Post-thaw tests are then completed on the segment, providing even more data on each CBU. At this stage, we can then support the TCs with interpreting and evaluating CBU post-thaw data via the Post-thaw Data Clinic, which runs through our email inbox (cordsupport@anthonynolan.org). Any queries or concerns a TC or H&I lab may have about their post-thaw results can be submitted. These queries are forwarded to a panel of five expert bankers from the Anthony Nolan Cell Therapy Centre (ANCTC) and NHSBT CBB, for their opinions on “what good looks like”.

In addition to our core services, we provide a variety of training types, including:

• Presentations at international conferences and workshops
• Onsite or online training for TC and H&I lab staff
• Online mixed training sessions via teams, webinars, and internally for registry staff.

The aim of this is to promote best practice, to improve knowledge around cord blood, maintain confidence in dealing with this source of HSCs, and remind the transplant community that we’re available and ready to share our operational and technical expertise at every stage in the process of CBU acquisition whenever a TC may need it.

The CSP strives to provide support and streamline processes wherever possible for all our TCs. A good example of this was the launch of filtering of WMDA cord search results for all TCs back in September 2022. This ensures the list of CBUs sent to TC staff only includes those of a suitable cell dose for the patient based on their weight – sifting out any units with insufficient cell dose and making CBU selection a fraction more straightforward!

We’re also expanding the provision of our Checklists to all TCs as of November 2023, making it easier to compare CBU reports from different banks and to select the best units for patients.

The last five years have been filled with progress for the CSP, and we have plenty of ambition for the next five! Coming up in the CSP calendar are our Cord Blood Webinars in November 2023 and our two-day ‘Cord Residential’, designed to facilitate the sharing of state-of-the-art UCBT expertise, in March 2024.

Through supporting TCs in selecting, analysing, and utilising CBUs, the CSP aims to make cord blood provision as seamless as possible. In doing so, we hope to ensure patients can access the appropriate graft when needed, contributing to the vision in Anthony Nolan’s new organisational strategy: A future where every patient who needs us can survive and thrive.