Adult Stem Cell Transplant Program, Division of Hematology/Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, Florida, USA.
Curr Opin Oncol. 2010 Mar;22(2):122-9. doi: 10.1097/cco.0b013e328335a56e.
For many patients with relapsed or high-risk hematologic malignancies, allogeneic stem cell transplantation offers the best hope for cure. For patients lacking a suitable family or unrelated donor, umbilical cord blood provides a promising alternative graft source. Dramatic advances in cord blood transplantation (CBT) have been made in the past 2 decades, leading to a rapid expansion of CBT programs worldwide.
Promising new strategies, including double CBT and ex-vivo graft engineering, have improved myeloid and platelet engraftment rates and kinetics. However, delayed immune reconstitution and associated infectious morbidity and mortality remain a significant challenge, especially in adult CBT recipients. In adults, both impaired recipient thymopoiesis and the lack of transferred memory cells contribute to delayed T cell recovery, resulting in an increased risk of opportunistic infections.
Novel clinical approaches in CBT have improved outcomes, especially those associated with delays in myeloid and platelet engraftment. However, delayed immune reconstitution remains a great challenge. Novel strategies, including graft engineering approaches capable of improving T cell recovery, and pharmacologic interventions capable of preserving thymopoiesis and facilitating the recovery of a diverse functional T cell repertoire are being pursued; these approaches have great potential to further improve outcomes after CBT.
对于许多复发或高危血液系统恶性肿瘤患者来说，异基因造血干细胞移植是治愈的最佳希望。对于缺乏合适的家庭供者或无关供者的患者，脐带血提供了一种有前途的替代移植物来源。在过去的 20 年中，脐带血移植（CBT）取得了显著进展，导致全球 CBT 项目迅速扩张。
有前途的新策略，包括双 CBT 和体外移植物工程，提高了髓系和血小板植入率和动力学。然而，延迟的免疫重建以及由此导致的感染发病率和死亡率仍然是一个重大挑战，特别是在成人 CBT 受者中。在成人中，受者胸腺生成受损和缺乏转移的记忆细胞都导致 T 细胞恢复延迟，从而增加了机会性感染的风险。
CBT 中的新临床方法改善了结果，特别是那些与髓系和血小板植入延迟相关的结果。然而，延迟的免疫重建仍然是一个巨大的挑战。目前正在探索新的策略，包括能够改善 T 细胞恢复的移植物工程方法，以及能够保存胸腺生成和促进多样化功能 T 细胞库恢复的药物干预措施；这些方法有很大的潜力进一步改善 CBT 后的结果。
