Faculty Bibliography

Introduction Umbilical cord blood transplantation (UCBT) provides excellent outcomes for patients of diverse racial/ethnic backgrounds. In 2011, the U.S. Food and Drug Administration (FDA) required that unrelated UCBT be performed using either licensed UCB units or unlicensed UCB units distributed under an Investigational New Drug program (IND). Objectives The aim of this study was to determine the incidence of neutrophil engraftment and survival after UCBT using unlicensed cord blood units. Methods Under an FDA-accepted IND, the National Marrow Donor Program (NMDP) manages a prospective distribution protocol for unlicensed UCB units for patients with hematologic malignancies and other indications. Patients received UCBT between 2011 and 2014 and were transplanted at 114 U.S. transplant centers. UCB units came from 22 U.S. and 68 international CB banks. Fewer than 5% of available UCB units were licensed during the study period. Results In total, 982 adults and 607 children (354 pediatric patients with malignant disease [pediM] and 253 patients with nonmalignant disease [pediNM]) were treated. Median age was 30 years (<1-81 years); 34% of adults and 47% of children were non-white (Fig. 1). The median number of days to neutrophil engraftment (ANC >500/mm3) was 22, 20, and 19 days, for adults, pediM, and pediNM, respectively, with an engraftment incidence of 89%, 88%, and 92% at 42 days for adults, pediM, and pediNM, respectively. The incidence of acute graft-versus-host disease (GVHD) II-IV was 41% for adults, 38% for pediM, and 26% for pediNM. Chronic GVHD incidence was 28% for all cohorts. One-year overall survival (OS) was 55%, 67%, and 79% for adults, pediM, and pediNM, respectively. Race/ethnicity of the patient had no effect on OS; there was no benefit to receiving a race/ethnicity matched UCB unit. In multivariate analysis, younger age, earlystage disease, use of total body irradiation, and sex mismatch to male patients predicted improved OS for adults. Discussion In this large cohort of patients undergoing UCBT, excellent outcomes were seen in diverse racial/ethnic groups using unlicensed cord blood units. Cord blood collection expands access to diverse populations and accounted for 34% of transplants for black versus 10% for white patients through the NMDP in 2016. Unlicensed units serve a diverse population, are safe and effective, and should continue to be available. Future studies that compare outcomes between licensed and unlicensed units are warranted. (Figure Presented)

Several factors influence a judge's decision to transfer youthful defendants to juvenile court from adult court, including the forensic evaluator's ultimate opinion, the defendant's amenability to treatment, and public safety risk. In this commentary, we examine the constructs that evaluators must assess, as established by Kent v. United States (1966). We begin by outlining the legal history that led to the large population of youths currently in the adult criminal justice system nationwide and the negative consequences of their incarceration in adult settings. We consider the unique role of forensic psychologists and psychiatrists as experts in development, with special regard to their ability to assess and inform the court about amenability to treatment and emotional maturity. The determination of amenability to treatment is further explored through a review of the current literature examining the influence of diagnostic labeling on judicial decisions and the treatment response of adolescent offenders who have psychopathy features. We conclude with an update on the recent proposal for juvenile justice reform in the authors' state of New York.