Kwon Mi, Bautista Guiomar, Balsalobre Pascual, Sánchez-Ortega Isabel, Serrano David, Anguita Javier, Buño Ismael, Fores Rafael, Regidor Carmen, García Marco José A, Vilches Carlos, de Pablo Rosario, Fernández Manuel N, Gayoso Jorge, Duarte Rafael, Díez-Martín José Luis, Cabrera Rafael
Department of Hematology, Gregorio Marañón Institute of Health Research, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Department of Hematology, Hospital Universitario Puerta de Hierro, Madrid, Spain.
Biol Blood Marrow Transplant. 2014 Dec;20(12):2015-22. doi: 10.1016/j.bbmt.2014.08.024. Epub 2014 Sep 22.
Among the strategies to optimize engraftment of cord blood (CB) stem cell transplantation (SCT), single CB with the coinfusion of CD34(+) stem cells from an HLA-mismatched auxiliary donor (haplo-cord) provides a valid alternative for adult patients without a suitable donor. A total of 132 high-risk adult patients with hematological malignancies from 3 Spanish institutions underwent myeloablative haplo-cord SCT. The median age was 37 years and median weight was 70 kg; 37% had active disease. The median number of postprocessing CB total nucleated and CD34(+) cells was 2.4 × 10(7)/kg (interquartile range [IQR], 1.8 to 2.9) and 1.4 × 10(5)/kg (IQR, .9 to 2), respectively. Neutrophil engraftment occurred in a median of 11.5 days (IQR, 10.5 to 16.5) and platelet engraftment at 36 days (IQR, 25.5 to 77). Graft failure was 2% overall and only 9% for CB. Cumulative incidence of acute graft-versus-host disease (GHVD) grades II to IV was 21% and cumulative incidence of chronic GVHD was 21%. Median follow-up was 60 months (range, 3.5 to 163). Overall survival was 43.5%, event-free survival was 38.3%, nonrelapse mortality was 35%, and relapse was 20% at 5 years. Myeloablative haplo-cord SCT results in fast engraftment of neutrophils and platelets, low incidences of acute and chronic GVHD, and favorable long-term outcomes using single CB units with relatively low cell content. Moreover, CB cell dose had no impact on CB engraftment and survival in this study. Therefore, haplo-cord SCT expands donor availability while reducing CB cell dose requirements.
在优化脐血（CB）干细胞移植（SCT）植入的策略中，单份CB与来自HLA不相合辅助供体的CD34(+)干细胞共同输注（单倍体脐血）为没有合适供体的成年患者提供了一种有效的替代方案。来自西班牙3家机构的132例患有血液系统恶性肿瘤的高危成年患者接受了清髓性单倍体脐血SCT。中位年龄为37岁，中位体重为70kg；37%的患者有活动性疾病。处理后CB总有核细胞和CD34(+)细胞的中位数分别为2.4×10(7)/kg（四分位间距[IQR]，1.8至2.9）和1.4×10(5)/kg（IQR，0.9至2）。中性粒细胞植入的中位时间为11.5天（IQR，10.5至16.5），血小板植入时间为36天（IQR，25.5至77）。总体移植失败率为2%，CB移植失败率仅为9%。急性移植物抗宿主病（GVHD）II至IV级的累积发生率为21%，慢性GVHD的累积发生率为21%。中位随访时间为60个月（范围，3.5至163）。5年时总生存率为43.5%，无事件生存率为38.3%，非复发死亡率为35%，复发率为20%。清髓性单倍体脐血SCT可使中性粒细胞和血小板快速植入，急性和慢性GVHD的发生率较低，使用细胞含量相对较低的单份CB单位可获得良好的长期结果。此外。在本研究中，CB细胞剂量对CB植入和生存没有影响。因此，单倍体脐血SCT扩大了供体来源，同时降低了对CB细胞剂量的要求。
