Laughlin M J, Barker J, Bambach B, Koc O N, Rizzieri D A, Wagner J E, Gerson S L, Lazarus H M, Cairo M, Stevens C E, Rubinstein P, Kurtzberg J
Department of Medicine, Ireland Cancer Center at University Hospitals of Cleveland and Case Western Reserve University, OH 44106-5065, USA.
N Engl J Med. 2001 Jun 14;344(24):1815-22. doi: 10.1056/NEJM200106143442402.
Umbilical-cord blood from unrelated donors who are not HLA-identical with the recipients can restore hematopoiesis after myeloablative therapy in children. We studied the use of transplantation of umbilical-cord blood to restore hematopoiesis in adults.
Sixty-eight adults with life-threatening hematologic disorders received intensive chemotherapy or total-body irradiation and then transplants of HLA-mismatched umbilical-cord blood. We evaluated the outcomes in terms of hematologic reconstitution, the occurrence of acute and chronic graft-versus-host disease (GVHD), relapses, and event-free survival.
Of the 68 patients, 48 (71 percent) received grafts of umbilical-cord blood that were mismatched for two or more HLA antigens. Of the 60 patients who survived 28 days or more after transplantation, 55 had neutrophil engraftment at a median of 27 days (range, 13 to 59). The estimated probability of neutrophil recovery in the 68 patients was 0.90 (95 percent confidence interval, 0.85 to 1.0). The presence of a relatively high number of nucleated cells in the umbilical-cord blood before it was frozen was associated with faster recovery of neutrophils. Severe acute GVHD (of grade III or IV) occurred in 11 of 55 patients who could be evaluated within the first 100 days after transplantation. Chronic GVHD developed in 12 of 33 patients who survived for more than 100 days after transplantation. The median follow-up for survivors was 22 months (range, 11 to 51). Of the 68 patients, 19 were alive and 18 of these (26 percent) were disease-free 40 months after transplantation. The presence of a high number of CD34+ cells in the graft was associated with improved event-free survival (P=0.05).
Umbilical-cord blood from unrelated donors can restore hematopoiesis in adults who receive myeloablative therapy and is associated with acceptable rates of severe acute and chronic GVHD.
来自与受者HLA不匹配的无关供者的脐带血能够在儿童进行清髓性治疗后恢复造血功能。我们研究了使用脐带血移植来恢复成人的造血功能。
68例患有危及生命的血液系统疾病的成人接受了强化化疗或全身照射，然后接受了HLA不匹配的脐带血移植。我们从血液学重建、急性和慢性移植物抗宿主病（GVHD）的发生、复发以及无事件生存期方面评估了结果。
68例患者中，48例（71%）接受了与两个或更多HLA抗原不匹配的脐带血移植。在移植后存活28天或更长时间的60例患者中，55例出现中性粒细胞植入，中位时间为27天（范围13至59天）。68例患者中性粒细胞恢复的估计概率为0.90（95%置信区间，0.85至1.0）。冷冻前脐带血中相对较高数量的有核细胞与中性粒细胞更快恢复相关。在移植后100天内可评估的55例患者中，11例发生了严重急性GVHD（III级或IV级）。33例移植后存活超过100天的患者中，12例发生了慢性GVHD。存活者的中位随访时间为22个月（范围11至51个月）。68例患者中，19例存活，其中18例（26%）在移植后40个月无疾病。移植物中大量CD34+细胞的存在与改善的无事件生存期相关（P=0.05）。
来自无关供者的脐带血能够在接受清髓性治疗的成人中恢复造血功能，并且与严重急性和慢性GVHD的可接受发生率相关。
