Wagner J E, Kernan N A, Steinbuch M, Broxmeyer H E, Gluckman E
Department of Pediatrics, University of Minnesota, School of Medicine, Minneapolis 55455, USA.
Lancet. 1995 Jul 22;346(8969):214-9. doi: 10.1016/s0140-6736(95)91268-1.
Allogeneic bone marrow transplantation is limited by the availability of suitable marrow donors and risk of graft-versus-host disease (GVHD) and opportunistic infection. In an attempt to ameliorate these limitations, umbilical cord blood has been postulated as an alternative source of allogeneic haemopoietic stem cells for transplantation. From September, 1994, umbilical cord blood from sibling donors has been used to reconstitute haemapoiesis in 44 children with acquired or congenital lympho-haemapoietic disorders, neuroblastoma, or metabolic diseases. Patients who had HLA-identical and HLA-1 antigen disparate grafts, had a probability of engraftment at 50 days after transplantation of 85%. No patient had late graft failure. The probability of grade II-IV GVHD at 100 days was 3% and the probability of chronic GVHD at one year was 6%. With a median follow-up of 1.6 years, the probability of survival for recipients of HLA-identical or HLA-1 antigen disparate grafts is 72%. We conclude that umbilical cord blood is a sufficient source of transplantable haemopoietic stem cells for children with HLA-identical or HLA-1 antigen disparate sibling donors with very low risk of acute or extensive chronic GVHD. The feasibility of umbilical-cord-blood transplantation with HLA-2 and HLA-3 antigen disparate sibling donors remains to be determined.
异基因骨髓移植受到合适骨髓供体的可及性、移植物抗宿主病（GVHD）和机会性感染风险的限制。为了改善这些限制，脐带血已被假定为移植用异基因造血干细胞的替代来源。自1994年9月以来，来自同胞供体的脐带血已被用于44例患有获得性或先天性淋巴造血系统疾病、神经母细胞瘤或代谢性疾病的儿童的造血重建。接受HLA相同但HLA-1抗原不同的移植物的患者，移植后50天的植入概率为85%。没有患者发生晚期移植物失败。100天时II-IV级GVHD的概率为3%，1年时慢性GVHD的概率为6%。中位随访1.6年，接受HLA相同或HLA-1抗原不同移植物的受者的生存概率为72%。我们得出结论，对于具有HLA相同或HLA-1抗原不同的同胞供体且急性或广泛慢性GVHD风险极低的儿童，脐带血是可移植造血干细胞的充足来源。与HLA-2和HLA-3抗原不同的同胞供体进行脐带血移植的可行性仍有待确定。
