[无关供者脐血移植治疗血液系统恶性肿瘤]

[Unrelated cord blood transplantation for the treatment of hematological malignancies].

作者信息

Ren Han-yun, Zhang Yao-chen, Huang Xiao-jun, Xu Lan-ping, Liu Kai-yan, Li Dan, Guo Nai-lan, Lu Dao-pei

机构信息

Institute of Hematology & People's Hospital, Peking University, Beijing 100044, China.

出版信息

Zhonghua Xue Ye Xue Za Zhi. 2003 Feb;24(2):82-5.

PMID:12697102

Abstract

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

摘要

目的

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。

方法

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。

结果

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。