Allogeneic haematopoietic stem cell transplant has become an import tool for the treatment of high risk and advanced haematological diseases. However, allogeneic transplantation has been limited by the availability of suitable related and unrelated donors. The positive results with umbilical cord blood as an alternative source of haematopoietic stem cells for transplantation in the paediatric setting encouraged studies in adult patients. In adults, however, the progress of cord blood transplantation has been slower, in part limited by the limitation of cell dose. We review here the current state of the art on cord blood transplantation for adults, and discuss some of the newer strategies being pursued in order to improve its safety and efficacy.