Hwang William Y K, Ong Shin Y
Singapore General Hospital, SingHealth, Singapore.
Ann Acad Med Singap. 2009 Apr;38(4):340-6.
Allogeneic haematopoietic stem cell transplantation (HSCT) has been used to treat a variety of malignant and non-malignant diseases. For patients who do not have a matched sibling donor or a optimally matched unrelated donor (MUD) for transplantation, other graft sources have been used, including mismatched haploidentical related donors and umbilical cord blood (CB).
A literature review and comparison of HSCT with MUD, haploidentical donors and CB donors was performed. The relative value of MUD and CB donor recruitment was calculated based on search-hit ratios of respective registries.
The choice of haematopoietic stem cell (HSC) source for transplantation remains difficult, and is dependent on disease stage, the centre's experience, HLA-matching and cell dose. It remains a lengthy procedure to identify and procure HSC from an acceptably matched unrelated donor, which may lead to disease progression in some patients. In these cases, alternatives such as haploidentical transplants or CB transplants can offer a chance for timely treatment. Although results of haploidentical transplant have improved in some centres, this approach is less successful in many other centres embarking on this transplant technique. However, there is the prospect of availability of HSC donors for almost every patient if the challenges of haploidentical HSCT can be overcome. CB transplantation has been established as a valid alternative for patients who cannot identify a suitably matched unrelated donor quickly enough. Some centres even prefer CB as a HSC source to unrelated donor bone marrow (BM) for paediatric patients.
Further increases in the size and diversity of CB inventories may realise the potential of every patient having access to at least a 5/6 matched CB unit of adequate cell dose (70-fold relative value for each CB unit banked versus each BM donor recruited). Prospective comparisons of MUD, CB, and haploidentical HSCT are needed to validate the optimal HSC source for transplant in specific diseases.
异基因造血干细胞移植（HSCT）已被用于治疗多种恶性和非恶性疾病。对于那些没有匹配的同胞供体或最佳匹配的无关供体（MUD）进行移植的患者，已采用其他移植物来源，包括不匹配的单倍体相合相关供体和脐带血（CB）。
对HSCT与MUD、单倍体相合供体和CB供体进行了文献综述和比较。根据各登记处的搜索命中率计算MUD和CB供体招募的相对价值。
选择用于移植的造血干细胞（HSC）来源仍然困难，这取决于疾病阶段、中心的经验、HLA匹配情况和细胞剂量。从匹配良好的无关供体中识别和获取HSC仍然是一个漫长的过程，这可能导致一些患者的疾病进展。在这些情况下，单倍体相合移植或CB移植等替代方法可以提供及时治疗的机会。尽管单倍体相合移植的结果在一些中心有所改善，但在许多开展这种移植技术的其他中心，这种方法不太成功。然而，如果能够克服单倍体相合HSCT的挑战，几乎每个患者都有获得HSC供体的前景。对于那些无法尽快找到合适匹配的无关供体的患者，CB移植已被确立为一种有效的替代方法。一些中心甚至更倾向于将CB作为儿科患者的HSC来源，而不是无关供体骨髓（BM）。
进一步增加CB库存的规模和多样性，可能实现每个患者都有机会获得至少一个细胞剂量充足的5/6匹配CB单位的潜力（每储存一个CB单位相对于每招募一个BM供体的相对价值为70倍）。需要对MUD、CB和单倍体相合HSCT进行前瞻性比较，以验证特定疾病中移植的最佳HSC来源。
