Bone Marrow Transplantation, Great Ormond Street Hospital, London, UK.
Br J Haematol. 2020 Sep;190(5):650-683. doi: 10.1111/bjh.16107. Epub 2019 Aug 13.
The first umbilical cord blood (UCB) transplantation was performed 30 years ago. UCB transplantation (UCBT) is now widely used in children with malignant and non-malignant disorders who lack a matched family donor. UCBT affords a lower incidence of graft-versus-host disease compared to alternative stem cell sources, but also presents a slower immune recovery and a high risk of infections if serotherapy is not omitted or targeted within the conditioning regimen. The selection of UCB units with high cell content and good human leucocyte antigen match is essential to improve the outcome. Techniques, such as double UCBT, ex vivo stem cell expansion and intra-bone injection of UCB, have improved cord blood engraftment, but clinical benefit remains to be demonstrated. Cell therapies derived from UCB are under evaluation as potential novel strategies to reduce relapse and viral infections following transplantation. In recent years, improvements within haploidentical transplantation have reduced the overall use of UCBT as an alternative stem cell source; however, each may have its relative merits and disadvantages and tailored use of these alternative stem cell sources may be the optimal approach.
30 年前进行了首例脐带血（UCB）移植。UCB 移植（UCBT）现在广泛应用于缺乏匹配家族供体的恶性和非恶性疾病的儿童。与其他干细胞来源相比，UCBT 导致移植物抗宿主病的发生率较低，但如果不在预处理方案中省略或靶向血清治疗，则免疫恢复较慢，感染风险较高。选择细胞含量高且人类白细胞抗原匹配良好的 UCB 单位对于改善结果至关重要。双 UCBT、体外干细胞扩增和 UCB 骨内注射等技术已提高了脐带血植入，但仍需证明其临床获益。源自 UCB 的细胞疗法正在作为减少移植后复发和病毒感染的潜在新策略进行评估。近年来，单倍体相合移植的改进减少了 UCBT 作为替代干细胞来源的总体应用；然而，每种方法都有其相对的优缺点，针对这些替代干细胞来源的个体化应用可能是最佳方法。
