Liu Hongtao, van Besien Koen
Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA,
Curr Hematol Malig Rep. 2015 Mar;10(1):1-7. doi: 10.1007/s11899-014-0245-y.
In the past decade, haplo-cord stem cell transplantation (SCT) using myeloablative or reduced intensive conditioning regimens has been shown to result in reliable and fast engraftment of neutrophils and platelets comparable to HLA-matched donors and much faster than after cord stem cell transplant. Haplo-cord SCT also has a low incidence of early non-relapse mortality, low incidences of acute and chronic graft-vs-host disease (GVHD), and excellent graft-vs-leukemia (GVL) effects. Favorable long-term outcomes for high-risk patients with hematologic malignancies have been reported, including older patients. Haplo-cord SCT will likely overcome the limitations of cell dose during cord stem cell selection and might significantly expand the use of cord stem cell transplant in the adult population. The comparable survival outcomes of matched related donor (MRD), matched unrelated donor (MUD), and haplo-cord stem cell transplant strongly argue that haplo-cord SCT should be considered as effective alternative stem cell transplant for high-risk patients lacking standard donors. Further improvement in supportive care and incorporation of a better understanding of the human fetal immune development into the haplo-cord SCT are required to further improve this strategy.
在过去十年中，采用清髓或减低强度预处理方案的单倍体脐血干细胞移植（SCT）已显示出能使中性粒细胞和血小板可靠且快速地植入，其效果与人类白细胞抗原（HLA）匹配的供体相当，且比脐血干细胞移植后更快。单倍体脐血SCT早期非复发死亡率也较低，急慢性移植物抗宿主病（GVHD）的发生率低，且具有出色的移植物抗白血病（GVL）效应。已有报道称，包括老年患者在内的血液系统恶性肿瘤高危患者可获得良好的长期预后。单倍体脐血SCT可能会克服脐血干细胞选择过程中细胞剂量的限制，并可能显著扩大脐血干细胞移植在成人中的应用。匹配的相关供体（MRD）、匹配的无关供体（MUD）和单倍体脐血干细胞移植具有相当的生存结果，这有力地表明，对于缺乏标准供体的高危患者，应将单倍体脐血SCT视为有效的替代干细胞移植方法。需要进一步改善支持治疗，并将对人类胎儿免疫发育的更好理解纳入单倍体脐血SCT，以进一步改进这一策略。
