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Pediatric hematology/oncology in Chang-Gung Memorial Hospital, Taipei was established in 1976. Not until 1992 that the division of pediatric hematology/oncology was born and relocated to the 6th floor of Chang-Gung Children's Hospital at Linkou, Taoyuan. Chang-Gung Children’ Hospital is a teaching hospital of Chang-Gung University. Our subspecialty ward has 30 inpatient beds, staffed with attending physicians, rotating residents, numbers of experienced nurses and pediatric oncology nurses.　Today, our team members consist of 3 board-certified pediatric hematologist /oncologists, 2 oncology nurse practitioners , 1 transplant coordinator, and 1 medical technologist. A clinical hematology laboratory offers facilities to perform general hematology and coagulation tests, including peripheral blood and bone marrow smears to be interpreted by the hematologist in charge of patients. This laboratory is established both for education and service purposes.

A chemotherapy room was designed for outpatient service. It is equipped with TV set, video, magazines, educational materials and brochures; it also has a small library supplying books for all ages. It is a venue for chemotherapy, blood transfusions, and procedures as well as a site for communications between nurse practitioners, oncology nurses and family members. It is also a place to hold educational sessions, counseling and patient-parent conferences. Family support group was established in 2001.

More than 14,000 cases have received umbilical cord blood (UCB) transplantation worldwide. In Taiwan, the pediatric hematopoietic stem cell transplantation (HSCT) team at Linko Chang Gung Memorial Hospital has the most fruitful experience for UCB transplantation. UCB transplantation is superior to the traditional bone marrow transplantation (BMT) because the donors are rapidly available. It shortens the time length to find the human leukocyte antigen (HLA)-matched unrelated donors.

Furthermore, UCB is less restricted with regards to HLA matching requirements relative to bone marrow stem cells owing to the low incidence of graft-versus-host disease (GVHD) post transplantation. UCB units are almost immediately available for transplant as they have been already stored at the cord blood bank. Such rapid availability is particularly useful for some patients who need urgent transplantation to cure their diseases. Double unit UCB transplantation improves the engraftment by increasing the number of stem cell transfused, and thus thereby broadening the range of potential clinical applications.

The hematopoietic stem cells derived from either UCB or bone marrow have the ability to divide into the various types of blood cells. These stem cells are what we need to transplant patients. There are two basic types of transplantation, autologous and allogeneic. In an autologous transplantation, the patient's own stem cells are used. In an allogeneic transplantation, the stem cells are donated by someone other than the patient. The stem cells can come from a sibling or an unrelated donor.

Umbilical cord blood transplantation provides a new opportunity for treating diseases.

Using stem cells from HLA-matched donors will decrease the risk for GVHD in an allogeneic HSCT.

The patient should be tissue typed at HLA-A, -B, and -DRB1 to identify the patient's HLA antigens. It is recommended that when possible, patients and donors (bone marrow) should be fully matched (6 of 6 loci) for HLA-A, -B, and -DRB1. At least, 5 out of 6 loci should be matched. Cord blood cells are naive. Their immune capabilities are immature, and therefore, the incidence of GVHD is lower. As a result, the criteria for HLA matching is less stringent compared to BMT. A 4 – 5 of 6 match for HLA-A, -B, and -DRB1 will permit a transplant. The time period for identifying the donor cord blood unit will be shortened.

UCB transplantation is developing in Taiwan now; however, it is not covered by the National Health Insurance. The policy in each medical institution is inconsistent, either. We started to perform UCB transplantation since 2003 at Linko Chang Gung Memorial Hospital. Our team is very experienced. We also have the outstanding results published in some famous international journals.

One study reported by H. Schoemans et al. in Bone Marrow Transplantation in 2006 pointed out that cord blood units are immediately available which is beneficial for patients with high risk hematological malignancies or rapidly progressive non-malignant diseases. However, this benefit is not fully applied in clinical practice. UCBT transplantation is usually reserved as a second-line therapy when the matched bone marrow cells are not available. There is a significant evolution in UCB transplantation over the past years. Based on the data from National Marrow Donor Program (NMDP) in 2008, the case number is greater for cord blood transplantation than for bone marrow transplantation among patients younger than 18 years old.

The goal of the pediatric HSCT team at Linko Chang Gung Memorial Hospital is to make transplantation available to all patients who require this treatment.