Gluckman E, Rocha V, Chastang C
Hôpital Saint Louis, Paris, France.
Vox Sang. 1998;74 Suppl 2:95-101. doi: 10.1111/j.1423-0410.1998.tb05403.x.
The number of cord blood transplants has been increasing very quickly with more than 250 cases reported to Eurocord Registry and more than 500 patients transplanted via the New York Cord Blood Bank. Cord blood transplants have been performed either with related or unrelated cord blood. Several cord blood banks established a group called Netcord whose goal is the standardization of the procedures, the organization of internal audits for accreditation and qualification, and the communication and exchange by internet of donor search on an international basis. More than 15,000 units of frozen cord blood are currently available and this number is increasing rapidly worldwide. Analysis of the clinical results has shown that related cord blood transplants give better results than unrelated cord blood transplants. Factors associated with better survival in related and unrelated cord blood transplants were lower age, diagnosis, with better results in inborn errors and in good risk children with acute leukemia. A larger number of nucleated cells in the transplant and the recipient being negative for CMV serology were also favourable risk factors for survival. Engraftment was improved with higher numbers of cells and HLA identity. Graft versus Host disease was reduced when compared to transplants of adult allogeneic bone marrow or peripheral blood progenitor cells. HLA disparities did not influence GVH; the only factor associated with increased GVH was positive CMV serology in the recipient. This study shows that cord blood is an alternative source of hematopoietic stem cells for allogeneic transplantation in children and in some adults. HLA disparity is not a limiting factor but the number of cells infused is important; currently the use of a number of nucleated cells inferior to 1 x 10(7)/kg is not recommended. Several questions remain including the criteria of choice of the donor, the indications in children and in adults, the comparison of cord blood transplants to other sources of hematopoietic stem cells and the role of growth factors and expansion for improving the speed of engraftment.
脐血移植的数量一直在迅速增加，向欧洲脐血库登记处报告的病例超过250例，通过纽约脐血库进行移植的患者超过500例。脐血移植可使用相关或无关供者的脐血。几家脐血库成立了一个名为Netcord的组织，其目标是实现程序标准化、组织内部审核以进行认证和资格认定，以及通过互联网在国际范围内就供者搜索进行沟通和交流。目前有超过15000单位的冷冻脐血可供使用，且这一数字在全球范围内正在迅速增加。临床结果分析表明，相关脐血移植的效果优于无关脐血移植。在相关和无关脐血移植中与更好生存相关的因素包括年龄较小、诊断情况，先天性疾病以及低危急性白血病患儿的移植效果更好。移植中核细胞数量较多以及受者CMV血清学检测为阴性也是生存的有利危险因素。细胞数量增加和HLA配型相合可改善植入情况。与成人同种异体骨髓或外周血祖细胞移植相比，移植物抗宿主病有所减少。HLA差异并不影响移植物抗宿主病；与移植物抗宿主病增加相关的唯一因素是受者CMV血清学检测呈阳性。这项研究表明，脐血是儿童和部分成人同种异体移植中造血干细胞的替代来源。HLA差异不是限制因素，但输入的细胞数量很重要；目前不建议使用低于1×10⁷/kg有核细胞数量的脐血。仍有几个问题有待解决，包括供者选择标准、儿童和成人的适应证、脐血移植与其他造血干细胞来源的比较，以及生长因子和细胞扩增在提高植入速度方面的作用。
