Ren Han-yun, Zhang Yao-chen, Huang Xiao-jun, Xu Lan-ping, Liu Kai-yan, Li Dan, Guo Nai-lan, Lu Dao-pei
Institute of Hematology & People's Hospital, Peking University, Beijing 100044, China.
Zhonghua Xue Ye Xue Za Zhi. 2003 Feb;24(2):82-5.
To investigate the engraftment, survival and graft-versus host disease (GVHD) after transplantation of unrelated cord blood for the treatment of childhood and adult hematological malignancies.
Seventeen patients (13 children and 4 adults) with hematological malignancies were enrolled in this study. Twelve patients were transplanted with one unit and 5 with 2 units of cord blood. There were HLA-matched in 6 and HLA-mismatched at 1 approximately 2 loci in 11 patients. Ten patients were transplanted at stable status, 7 at advanced stage of leukemia. Conditioning regimens were BU/CY for 13 and CY/TBI for 3 patients. Most patients received additional ATG at a dose of 15 approximately 20 mg x kg(-1) x d(-1) for 3 days. CsA, mycophenolate mofetil (MMF) and methylprednisolone were used for GVHD prophylaxis.
Fourteen patients survived more than 40 days after transplantation were evaluated for engraftment. At day 60 after UCBT, 86% and 71% of the patients showed neutrophil and platelet engraftment, respectively. The time for an absolute neutrophil count > or = 0.5 x 10(9)/L was (21.0 +/- 1.3) days and platelet > or = 20 x 10(9)/L was (39.0 +/- 10.3) days. Four patients developed grade II acute GVHD and 2 chronic GVHD. Of the 17 patients, 11 were still alive and 8 of them were in event-free status. For the 10 patients transplanted at stable status, 2 year overall survival is 90%, and event-free survival (EFS) 70%. However, for the 7 patients transplanted at advanced stage of leukemia, only 2 survived without relapse. Of the 4 adult patients, 2 had sustained engraftment and survived for 18 and 14 months, respectively.
HLA-matched or 1 approximately 2 loci-mismatched UCBT is a feasible procedure to cure a significant proportion of children or adults with leukemia, especially if performed in a favourable phase of disease. Two units of CBT can be used for adult patients if the cell number of one unit is not enough.
研究无关脐血移植治疗儿童及成人血液系统恶性肿瘤后的植入、存活及移植物抗宿主病（GVHD）情况。
17例血液系统恶性肿瘤患者（13例儿童和4例成人）纳入本研究。12例患者移植1个脐血单位，5例移植2个脐血单位。6例患者HLA匹配，11例患者HLA在约2个位点不匹配。10例患者在疾病稳定期移植，7例在白血病晚期移植。预处理方案中13例采用白消安/环磷酰胺（BU/CY），3例采用环磷酰胺/全身照射（CY/TBI）。大多数患者额外接受剂量为15～20mg·kg⁻¹·d⁻¹的抗胸腺细胞球蛋白（ATG），共3天。使用环孢素（CsA）、霉酚酸酯（MMF）和甲泼尼龙预防GVHD。
对移植后存活超过40天的14例患者进行植入评估。脐血移植后第60天，分别有86%和71%的患者中性粒细胞和血小板植入。中性粒细胞绝对计数≥0.5×10⁹/L的时间为（21.0±1.3）天，血小板≥20×10⁹/L的时间为（39.0±10.3）天。4例患者发生Ⅱ级急性GVHD，2例发生慢性GVHD。17例患者中，11例仍存活，其中8例处于无事件状态。对于10例在疾病稳定期移植的患者，2年总生存率为90%，无事件生存率（EFS）为70%。然而，对于7例在白血病晚期移植的患者，只有2例存活且未复发。4例成年患者中，2例实现持续植入，分别存活18个月和14个月。
HLA匹配或1～2个位点不匹配的脐血移植是治愈相当比例儿童或成人白血病的可行方法，尤其是在疾病的有利阶段进行移植。如果一个脐血单位的细胞数量不足，2个脐血单位可用于成年患者。
