**5. Conclusion**

Because of the two- to threefold increased availability of high-cell dose CB products as a result of MaxCell CB processing, and the outstanding clinical outcome observed to date, it may be appropriate to ask whether it is reasonable to discard all the stem cell, progenitor cell, nucleated cell, and mononuclear cell in order to preserve storage space and reduce cost [13]. In fact, even the space cost savings argument is probably negated by the increased potential revenue generated from much higher availability of high-cell dose CB products. However, more importantly, is whether depriving patients of the opportunity to access the same HLA-matched CB products with higher cell doses can be justified in the name of economics. Cost, the original reason NYBC developed these RCR techniques, appears to be insufficient [13] if cell dose and in turn, clinical outcome and patient survival are compromised. As an example, a 25% improvement in infused cell dose can take a product from a suboptimal 2.0 × 107 TNC/kg body weight to an adequate 2.5 × 107 TNC/kg body weight.

To summarize, The results of outcome of the patients in the first MaxCell series [18] appear to be at least comparable to those reported in the medical literature [19, 23–34] and in some instances, superior to those reported for RCR CB products [18, 35–43, 50–59]. Though, there are no published data indicating inferior outcomes with transplantation using MaxCell units [8, 35–43, 50–59], such retrospective comparisons cannot be definitive. To analyze rigorously the outcomes of MaxCell CBT in comparison with RCR units, matched-pair comparisons for pediatric hematologic malignancies and thalassemia have shown significant improvements in overall survival, disease-free survival, transplanted-related mortality, and platelet engraftment for MaxCell CB products [35–38]. Moreover, when MaxCell CB products are coupled with direct infusion, significantly improved overall survival, disease-free survival, transplantedrelated mortality, neutrophil, and platelet engraftment, higher limited cGvHD but lower extensive cGvHD have been reported and subsequently confirmed in matched-pair comparisons. In conclusion, CB transplants using products processed by MaxCell CB processing technologies provide clinical outcome results that appear superior to results reported with the use of 1st Gen RCR units. When combined with bedside thaw techniques in most situations, further improvements can be expected [56–59].
