Jacobsohn D A, Hewlett B, Ranalli M, Seshadri R, Duerst R, Kletzel M
Department of Pediatrics, Division of Hematology/Oncology and Stem Cell Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL 60614, USA.
Bone Marrow Transplant. 2004 Nov;34(10):901-7. doi: 10.1038/sj.bmt.1704681.
Acute lymphocytic leukemia (ALL) is a common indication for hematopoietic stem cell transplantation (HSCT) in children. Use of unrelated cord blood (UCB) has become increasingly popular as a stem cell source, given the rapid availability and decreased GVHD potential. Publications describing outcomes of children with leukemia who underwent UCB transplants have compared them to those having received unrelated donor marrow transplants. Results are similar. We compared our outcomes using UCB vs allogeneic-related hematopoietic stem cells in pediatric ALL patients since 1992. A total of 49 patients were analyzed. All patients were either in CR1 with high-risk features (n=21) or in CR2 (n=28) with initial remission less than 36 months. Patients received myeloablation with fractionated total body irradiation, cyclophosphamide, and etoposide and GVHD prophylaxis with cyclosporine and methotrexate. Antithymocyte globulin was added for UCB recipients to address the HLA differences. In all, 23 patients underwent allogeneic -related HSCT and 26 underwent UCB transplantation. Other than increased time to engraftment for UCB recipients, results are equivalent. The 3-year overall survival is 64% and 3-year event-free survival is 60% for both groups. Rates of GVHD and transplant-related mortality are also equivalent. UCB is a reasonable option for children with ALL who are referred for HSCT.
急性淋巴细胞白血病（ALL）是儿童造血干细胞移植（HSCT）的常见适应症。鉴于无关脐血（UCB）可快速获取且移植物抗宿主病（GVHD）发生可能性降低，其作为干细胞来源越来越受欢迎。描述接受UCB移植的白血病患儿治疗结果的出版物将这些患儿与接受无关供体骨髓移植的患儿进行了比较。结果相似。自1992年以来，我们比较了小儿ALL患者使用UCB与使用同种异体相关造血干细胞的治疗结果。共分析了49例患者。所有患者要么处于具有高危特征的CR1期（n = 21），要么处于初始缓解期少于36个月的CR2期（n = 28）。患者接受了分次全身照射、环磷酰胺和依托泊苷进行清髓，并使用环孢素和甲氨蝶呤预防GVHD。对于UCB受者，添加了抗胸腺细胞球蛋白以解决HLA差异问题。总共有23例患者接受了同种异体相关HSCT，26例接受了UCB移植。除了UCB受者的植入时间延长外，结果相当。两组的3年总生存率均为64%，3年无事件生存率均为60%。GVHD发生率和移植相关死亡率也相当。对于被转诊接受HSCT的ALL患儿，UCB是一个合理的选择。
