Blood and Marrow Transplant Service, Westmead Hospital, Sydney, New South Wales, Australia.
Intern Med J. 2009 Nov;39(11):744-51. doi: 10.1111/j.1445-5994.2008.01825.x. Epub 2008 Nov 3.
Unrelated umbilical cord blood has emerged as an alternative stem cell source for allogeneic transplantation for patients with haematological malignancies, but in adults is limited by the low number of stem cells present in banked cord blood units. We report our experience with double cord blood transplants for adult patients. The aim of the study was to compare the outcomes of double unrelated cord blood transplants in adults with poor prognosis haematological diseases with single cord blood transplants.
Eleven patients, median age 27 years and median weight 69 kg, received transplants of two partially matched unrelated cord blood units after myeloablative conditioning therapy.
Neutrophil recovery to 0.5 x 10(9)/L was seen by median day 32 (18-53), and platelet recovery to 50 x 10(9)/L by day 91 (56-381). These results were not significantly different from those reported in patients receiving single cord blood transplants. Acute graft-versus-host disease of grades II-IV was seen in four patients, but no chronic graft-versus-host disease occurred. Transplant-related complications were responsible for the deaths of five patients in the first 3 months post-transplant, whereas two patients died of relapse of their haematological malignancy. Four patients survive, disease free, 17-33 months post-transplant.
Transplantation using two partially matched unrelated cord blood units did not appear to result in improvements either in engraftment or survival, as compared with a previous cohort of patients receiving single cord blood units. Further strategies appear to be needed to reduce the duration of severe neutropenia and reduce the high transplant-related mortality in these patients.
非亲缘脐带血已成为血液系统恶性肿瘤患者异基因移植的替代干细胞来源，但在成年人中，由于库存脐带血单位中存在的干细胞数量较少而受到限制。我们报告了我们在成人患者中进行双脐带血移植的经验。本研究的目的是比较预后不良的血液病成人患者接受双非亲缘脐带血移植和单脐带血移植的结果。
11 名患者，中位年龄 27 岁，中位体重 69kg，在清髓性条件治疗后接受了两个部分匹配的非亲缘脐带血单位的移植。
中性粒细胞恢复至 0.5x10(9)/L 的中位数时间为第 32 天（18-53 天），血小板恢复至 50x10(9)/L 的中位数时间为第 91 天（56-381 天）。这些结果与接受单脐带血移植的患者报告的结果没有显著差异。4 名患者发生 II-IV 级急性移植物抗宿主病，但无慢性移植物抗宿主病发生。移植相关并发症是移植后 3 个月内 5 名患者死亡的原因，而 2 名患者死于血液系统恶性肿瘤复发。4 名患者无病生存，移植后 17-33 个月。
与之前接受单脐带血移植的患者队列相比，使用两个部分匹配的非亲缘脐带血单位移植似乎并没有改善植入或生存。似乎需要进一步的策略来减少严重中性粒细胞减少症的持续时间，并降低这些患者的高移植相关死亡率。
