Rubinstein P, Carrier C, Scaradavou A, Kurtzberg J, Adamson J, Migliaccio A R, Berkowitz R L, Cabbad M, Dobrila N L, Taylor P E, Rosenfield R E, Stevens C E
F.H. Allen Laboratory of Immunogenetics, New York Blood Center, NY 10021, USA.
N Engl J Med. 1998 Nov 26;339(22):1565-77. doi: 10.1056/NEJM199811263392201.
A program for banking, characterizing, and distributing placental blood, also called umbilical-cord blood, for transplantation provided grafts for 562 patients between August 24, 1992, and January 30, 1998. We evaluated this experience.
Placental blood was stored under liquid nitrogen and selected for specific patients on the basis of HLA type and leukocyte content. Patients were prepared for the transplantation of allogeneic hematopoietic cells in the placental blood and received prophylaxis against graft-versus-host disease (GVHD) according to routine procedures at each center.
Outcomes at 100 days after transplantation were known for all 562 patients, and outcomes at 1 year for 94 percent of eligible recipients. The cumulative rates of engraftment among the recipients, according to actuarial analysis, were 81 percent by day 42 for neutrophils (median time to engraftment, 28 days) and 85 percent by day 180 for platelets (median, day 90). The speed of myeloid engraftment was associated primarily with the leukocyte content of the graft, whereas transplantation-related events were associated with the patient's underlying disease and age, the number of leukocytes in the graft, the degree of HLA disparity, and the transplantation center. After engraftment, age, HLA disparity, and center were the primary predictors of outcome. Severe acute GVHD (grade III or IV) occurred in 23 percent of patients, and chronic GVHD occurred in 25 percent. The rate of relapse among recipients with leukemia was 9 percent within the first 100 days, 17 percent within 6 months, and 26 percent by 1 year. These rates were associated with the severity of GVHD, type of leukemia, and stage of the disease.
Placental blood is a useful source of allogeneic hematopoietic stem cells for bone marrow reconstitution.
一个用于储存、鉴定和分配胎盘血（也称为脐带血）以供移植的项目，在1992年8月24日至1998年1月30日期间为562例患者提供了移植物。我们对这一经验进行了评估。
胎盘血储存在液氮中，并根据HLA类型和白细胞含量为特定患者进行选择。患者接受了胎盘血中同种异体造血细胞移植的预处理，并按照各中心的常规程序接受了移植物抗宿主病（GVHD）的预防。
所有562例患者移植后100天的结果已知，94%符合条件的受者1年的结果已知。根据精算分析，受者中中性粒细胞在第42天时的累积植入率为81%（植入的中位时间为28天），血小板在第180天时的累积植入率为85%（中位时间为第90天）。髓系植入的速度主要与移植物中的白细胞含量相关，而与移植相关的事件则与患者的基础疾病和年龄、移植物中的白细胞数量、HLA不相配程度以及移植中心有关。植入后，年龄、HLA不相配程度和中心是结果的主要预测因素。23%的患者发生了严重急性GVHD（III级或IV级），25%的患者发生了慢性GVHD。白血病受者在移植后100天内的复发率为9%，6个月内为17%，1年内为26%。这些复发率与GVHD的严重程度、白血病类型和疾病分期有关。
胎盘血是用于骨髓重建的同种异体造血干细胞的有用来源。
