Rocha V, Chastang C, Souillet G, Pasquini R, Plouvier E, Nagler A, Locatelli F, Saarinen U, Cornu G, Bernaudin F, Gluckman E
Hôpital St Louis, Paris, France.
Bone Marrow Transplant. 1998 Jun;21 Suppl 3:S59-62.
Eurocord Transplant has established a registry for studying results of cord blood transplant. We have analyzed 78 patients who have received a related CBT between October 1988 and December 1996. The median follow-up time was 29 months (1-99). The median age was 5 years (0.2-20), median weight 19 kg (5-50). Forty-six patients had a malignant disease: 32 acute leukemia (AL), six chronic myeloid leukemia (CML), four myelodysplastic syndrome, two neuroblastoma and two non-Hodgkin lymphoma. Thirty-two patients were transplanted for non-malignant diseases including 17 bone marrow failure syndromes (BMFS), three sickle cell anemia, five thalassemia and seven inborn errors. The donor was an HLA-identical sibling in 60 cases and an HLA-mismatched donor in 18 cases. As conditioning, 36 patients received irradiation and 40 patients received associated busulfan-containing regimens. GVHD prophylaxis consisted of CsA alone in 36 cases, CsA associated with prednisone in eight cases, CsA, methotrexate (Mtx) with or without prednisone in 28 cases and CsA with monoclonal antibody or ATG in four cases. The median number of nucleated cells (NC) infused/kg was 3.9 x 10(7) (0.7-15). One-year survival was 63 +/- 6%. Age, weight, HLA identity and negative cytomegalovirus (CMV) serology in the recipient were significant favorable prognostic factors. Among these 78 patients, the incidence of grade > or = II GVHD was 9% in HLA-matched CBT and 50% in mismatched CBT (P < 0.001). Neutrophil engraftment was associated with age <6 years (P = 0.02) and weight <20 kg (P = 0.02). It was 73% in patients receiving <3.7 x 10(7) nucleated cells (NC) infused/kg and 85% in patients receiving more (P = 0.06). Favorable factors for platelets engraftment were age <6 years (P = 0.03), weight <20 kg (P = 0.002) and HLA identity (P < 0.0001). Related cord blood transplantation offers a good alternative to BMT. Theses results are in favor of freezing cord blood in families in whom a transplant might be indicated.
欧洲脐带血移植协会已建立了一个用于研究脐带血移植结果的登记系统。我们分析了1988年10月至1996年12月期间接受相关脐带血移植的78例患者。中位随访时间为29个月（1 - 99个月）。中位年龄为5岁（0.2 - 20岁），中位体重19千克（5 - 50千克）。46例患者患有恶性疾病：32例急性白血病（AL）、6例慢性粒细胞白血病（CML）、4例骨髓增生异常综合征、2例神经母细胞瘤和2例非霍奇金淋巴瘤。32例患者因非恶性疾病接受移植，包括17例骨髓衰竭综合征（BMFS）、3例镰状细胞贫血、5例地中海贫血和7例先天性代谢缺陷病。供者为HLA全相合同胞的有60例，HLA不相合供者的有18例。作为预处理方案，36例患者接受了放疗，40例患者接受了含白消安的联合方案。移植物抗宿主病（GVHD）预防措施中，36例患者单独使用环孢素（CsA），8例患者使用CsA联合泼尼松，28例患者使用CsA、甲氨蝶呤（Mtx）联合或不联合泼尼松，4例患者使用CsA联合单克隆抗体或抗胸腺细胞球蛋白（ATG）。输注的有核细胞（NC）中位数为每千克3.9×10⁷（0.7 - 15）。1年生存率为63±6%。患者的年龄、体重、HLA相合性以及受者巨细胞病毒（CMV）血清学阴性是显著的有利预后因素。在这78例患者中，HLA相合的脐带血移植中≥Ⅱ级GVHD的发生率为9%，不相合的脐带血移植中为50%（P < 0.001）。中性粒细胞植入与年龄<6岁（P = 0.02）和体重<20千克（P = 0.02）相关。每千克输注有核细胞（NC）<3.7×10⁷的患者中植入率为73%，输注更多的患者中为85%（P = 0.06）。血小板植入的有利因素为年龄<6岁（P = 0.03）、体重<20千克（P = 0.002）和HLA相合性（P < 0.0001）。相关脐带血移植为骨髓移植（BMT）提供了一个很好的替代方案。这些结果支持在可能需要进行移植的家庭中冷冻脐带血。
