Thomson B G, Robertson K A, Gowan D, Heilman D, Broxmeyer H E, Emanuel D, Kotylo P, Brahmi Z, Smith F O
Stem Cell Transplantation Program, Department of Pediatric Hematology/ Oncology, Indiana University School of Medicine, Indianapolis, USA.
Blood. 2000 Oct 15;96(8):2703-11.
Unrelated cord blood (UCB) is being used as a source of alternative hematopoietic stem cells for transplantation with increasing frequency. From November 1994 to February 1999, 30 UCB transplant procedures were performed for both malignant and nonmalignant diseases in 27 children, aged 0.4 to 17.1 years. Patients received either HLA-matched (n = 3) or 1- or 2-antigen-mismatched (n = 27) UCB following 1 of 2 standardized preparative and graft-versus-host disease regimens (hyperfractionated total body irradiation, cyclophosphamide, and antithymocyte globulin [ATG] with cyclosporine A and methotrexate; or busulfan, melphalan, and ATG with cyclosporine A and prednisone). The median time to neutrophil and platelet engraftment was 27 days (12-60 days) and 75 days (33-158 days) posttransplantation, respectively. No correlation was noted between neutrophil and platelet engraftment and nucleated cells per kilogram, CD34(+) cells per kilogram infused, or cytomegalovirus status of recipient. The cumulative probability of acute grade 2 or greater graft-versus-host disease (GVHD) was 37.2%, and of grade 3 or greater GVHD was 8.8%. No patients developed chronic GVHD. CD4, CD19, and natural killer cell recovery was achieved at a median of 12, 6, and 2 months, respectively. CD8 recovery was delayed at a median of 9 months. Normal mitogen response was achieved at 6 to 9 months. The probability of survival, disease-free survival, and event-free survival at 1 year was 52.3% (34.1%-70.5%), 54.7% (34.5%-74.9 %) and 49.6% (29.9%-69.4%), respectively. This series of 30 UCB transplants suggests that although CD8 cell recovery is delayed, the pattern of immune reconstitution with UCB is similar to that reported for other stem cell sources. (Blood. 2000;96:2703-2711)
无关供者脐血（UCB）正越来越频繁地被用作造血干细胞移植的替代来源。1994年11月至1999年2月，对27名年龄在0.4至17.1岁的儿童进行了30例UCB移植手术，治疗恶性和非恶性疾病。患者接受了HLA匹配（n = 3）或1个或2个抗原不匹配（n = 27）的UCB，采用2种标准化预处理和移植物抗宿主病方案中的1种（超分割全身照射、环磷酰胺以及抗胸腺细胞球蛋白[ATG]联合环孢素A和甲氨蝶呤；或白消安、美法仑以及ATG联合环孢素A和泼尼松）。移植后中性粒细胞和血小板植入的中位时间分别为27天（12 - 60天）和75天（33 - 158天）。未发现中性粒细胞和血小板植入与每千克有核细胞数、每千克输注的CD34(+)细胞数或受者巨细胞病毒状态之间存在相关性。急性2级或更高级别移植物抗宿主病（GVHD）累计发生率为3�2%，3级或更高级别GVHD累计发生率为8.8%。无患者发生慢性GVHD。CD4、CD19和自然杀伤细胞恢复的中位时间分别为12个月、6个月和2个月。CD8恢复延迟，中位时间为9个月。6至9个月时达到正常的丝裂原反应。1年时的生存率、无病生存率和无事件生存率分别为52.3%（34.1% - 70.5%）、54.7%（34.5% - 74.9%）和49.6%（29.9% - 69.4%）。这一系列30例UCB移植表明，尽管CD8细胞恢复延迟，但UCB免疫重建模式与其他干细胞来源所报道的相似。（《血液》。2000年；96:2703 - 2711）
