Gluckman Eliane, Rocha Vanderson
Department of Hematology Bone Marrow Transplant, EUROCORD, Institute of Hematology, APHP Hospital Saint Louis, Paris, France.
Curr Opin Immunol. 2006 Oct;18(5):565-70. doi: 10.1016/j.coi.2006.07.014. Epub 2006 Aug 8.
The number of unrelated cord blood transplants is increasing, with more than 8000 patients reported worldwide. Criteria of donor choice have been identified. Cell dose measured by number of nucleated cells is the most important factor, thus increases in cell dose can partially overcome the presence of HLA incompatibilities. Overall, increasing the number of HLA incompatibilities is associated with non-engraftment, but it also decreases the risk of relapse in patients with malignant disease, resulting in an absence of effect of HLA incompatibilities on event-free survival (survival without relapse or complications related to the transplant). However, in patients with non-malignant disorders, increasing the number of HLA incompatibilities decreases the overall survival. These results show that criteria of donor choice based on number of infused cells, number of HLA incompatibilities and diagnosis improve outcomes of unrelated cord blood transplants. Currently, owing to the possibility of using a non HLA identical donor, most patients can find a donor, increasing the need for the development of the inventory of cord blood banks. Methods of improving engraftment are currently under investigation.
非亲缘脐血移植的数量正在增加，全球报告的患者超过8000例。已确定了供体选择标准。通过有核细胞数量测量的细胞剂量是最重要的因素，因此细胞剂量的增加可部分克服HLA不相合的影响。总体而言，HLA不相合数量的增加与植入失败相关，但也降低了恶性疾病患者的复发风险，导致HLA不相合对无事件生存期（无复发或与移植相关并发症的生存期）没有影响。然而，在患有非恶性疾病的患者中，HLA不相合数量的增加会降低总体生存率。这些结果表明，基于输注细胞数量、HLA不相合数量和诊断的供体选择标准可改善非亲缘脐血移植的结果。目前，由于有可能使用HLA不相同的供体，大多数患者都能找到供体，这增加了开发脐血库库存的需求。目前正在研究改善植入的方法。
