Takahashi Satoshi, Asano Shigetaka
Institute of Medical Science, University of Tokyo, 6-1, 4 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan.
Gan To Kagaku Ryoho. 2004 Mar;31(3):307-13.
Unrelated cord blood transplantation (CBT) has now become more common. In the last decade, CBT has increasingly been utilized not only for children, but also for adults. As a source of hematopoietic stem cells (HSCs), umbilical cord blood has the advantages of speed of availability, tolerance of 1-2 antigen HLA mismatch, and a low incidence of severe graft-versus-host disease (GVHD). Thus, UCB represents a highly convenient HSC source that may significantly extend the HSC donor pool. As graft cell dose is the major factor determining hematopoietic recovery and survival in CBT, methods to increase cell dose such as multiple-unit transplant and ex vivo expansion, or to increase stem cell homing such as intra-bone transplantation are being pursued. We could also speculate the existence of unique pathophysiology of acute GVHD after CBT compared with after bone marrow transplantation due to our clinical analysis. It might be very important to establish new standard management including immunosuppressive procedure after CBT to consistently keep better clinical results. Umbilical cord blood is promising alternative to bone marrow-derived stem cells. More prospective studies are needed to establish the role of CBT during various allogeneic HSC transplantations.
无关供者脐血移植（CBT）如今已变得更为常见。在过去十年中，CBT不仅越来越多地应用于儿童，也应用于成人。作为造血干细胞（HSC）的来源，脐血具有可快速获取、能耐受1 - 2个抗原HLA错配以及严重移植物抗宿主病（GVHD）发生率低等优点。因此，脐血是一种非常便利的HSC来源，可显著扩大HSC供者库。由于移植物细胞剂量是决定CBT中造血恢复和生存的主要因素，目前正在探索增加细胞剂量的方法，如多单位移植和体外扩增，或增加干细胞归巢的方法，如骨内移植。基于我们的临床分析，我们还可以推测与骨髓移植后相比，CBT后急性GVHD存在独特的病理生理学机制。建立包括CBT后免疫抑制程序在内的新的标准管理方法，以持续保持更好的临床效果可能非常重要。脐血是骨髓来源干细胞很有前景的替代物。需要更多前瞻性研究来确立CBT在各种异基因HSC移植中的作用。
