Yamane Takahisa, Nakamae Hirohisa, Hasegawa Taro, Terada Yoshiki, Hagihara Kiyoyuki, Ohta Kensuke, Hino Masayuki
Department of Clinical Hematology and Clinical Diagnostics, Osaka City University, Graduate School of Medicine, Japan.
Osaka City Med J. 2005 Dec;51(2):83-8.
Recently, clinical studies of cord blood transplantation (CBT) in adults after myeloablative or nonmyeloablative conditioning regimens showed cord blood (CB) could effectively restore hematopoiesis and was associated with acceptable levels of graft versus host disease (GVHD).
This study reports the results of cord blood transplantation in 7 adults with hematological malignancies.
Median age was 56 years (range, 43-69 years). HLA match was 4 of 6 in 4 cases and 5 of 6 in 3 cases. Median nucleated cell dose was 2.74 x 10(7) cells/kg (range, 2.13-3.80) and CD34+ cell dose was 1.15 x 10(5) cells/kg (range, 0.44-2.79). Three patients had primary graft failure. There was one early death at day 24 after CBT due to pneumonia. Three patients with engraftment are alive and free of disease at day 390, day 348 and day 164 after CBT. Acute GVHD grade II occurred in 2 cases with engraftment, and chronic GVHD occurred in 1 of 3 evaluable patients. Six patients with and without engraftment received more than 2.0 x 10(7) cells/kg nucleated cells. Three patients without engraftment received CD34+ cell dose less than that of 3 patients with engraftment.
It is considered that graft CD34+ cell dose besides nucleated cell dose is important for engraftment. We believe that adult patients without suitable related or unrelated bone marrow donors should be considered as candidates for CBT by the choice of CB including both sufficient nucleated cell dose and CD34+ cell dose.
最近，关于成人在清髓或非清髓预处理方案后进行脐血移植（CBT）的临床研究表明，脐血（CB）能够有效地恢复造血功能，并且与可接受水平的移植物抗宿主病（GVHD）相关。
本研究报告了7例患有血液系统恶性肿瘤的成人患者脐血移植的结果。
中位年龄为56岁（范围43 - 69岁）。4例患者的人类白细胞抗原（HLA）配型为6个位点中匹配4个，3例患者为6个位点中匹配5个。中位有核细胞剂量为2.74×10⁷个细胞/千克（范围2.13 - 3.80），CD34⁺细胞剂量为1.15×10⁵个细胞/千克（范围0.44 - 2.79）。3例患者发生原发性移植失败。1例患者在脐血移植后第24天因肺炎早期死亡。3例植入成功的患者在脐血移植后第390天、第348天和第164天存活且无疾病。2例植入成功的患者发生了II级急性移植物抗宿主病，3例可评估患者中有1例发生了慢性移植物抗宿主病。6例植入和未植入成功的患者接受的有核细胞剂量超过2.0×10⁷个细胞/千克。3例未植入成功的患者接受的CD34⁺细胞剂量低于3例植入成功的患者。
除有核细胞剂量外，移植物CD34⁺细胞剂量对植入也很重要。我们认为，对于没有合适的相关或无关骨髓供体的成年患者，通过选择含有足够有核细胞剂量和CD34⁺细胞剂量的脐血，应将其视为脐血移植的候选者。
