Placental blood as a source of hematopoietic stem cells for transplantation into unrelated recipients
Placental blood as a source of hematopoietic stem cells for transplantation into unrelated recipients
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DOI：
10.1056/nejm199607183350303
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发表时间：
1996-07-18
影响因子：
158.5
通讯作者：
Rubinstein, P
中科院分区：
文献类型：
--
作者：
Kurtzberg, J;Laughlin, M;Rubinstein, P
背景：非血缘关系供者的骨髓移植受限于缺乏匹配的供者和移植物抗宿主病(GVHD)的风险。来自兄弟姐妹捐献者的胎盘血可以重建造血。方法连续25例恶性和非恶性疾病患者，主要是儿童，接受非血缘关系供者的胎盘血，进行血液学和免疫学重建及GVHD的评估。移植前用血清学方法进行I类抗原配型，对II类等位基因进行低分辨分子分型。在供受者配对中，仅有一个以上不同的人类白细胞抗原或等位基因，进行高分辨率的II类人类白细胞抗原配型。对于两个抗原或等位基因错配的供受者对，采用高分辨分型法筛选最佳配型。结果25对供受者中有24对存在1对3个Hca抗原不匹配。在25名移植受者中，有23人接受了输注的造血干细胞移植。21例患者中有2例发生急性III级移植物抗宿主病，2例为慢性移植物抗宿主病。移植后60d检测T细胞和B细胞对植物有丝分裂原的体外增殖反应。中位随访时间为12个半月，最短随访时间为100d，总的100d生存率为%，总无事件生存率为48%。结论HLA型不合胎盘血是一种可用于儿童造血重建的干细胞来源。(C)1996年，马萨诸塞州医学会。
Background Transplantation of bone marrow from unrelated donors is limited by a lack of HLA-matched donors and the risk of graft-versus-host disease (GVHD). Placental blood from sibling donors can reconstitute hematopoiesis. We report preliminary results of transplantation using partially HLA-mismatched placental blood from unrelated donors.Methods Twenty-five consecutive patients, primarily children, with a variety of malignant and nonmalignant conditions received placental blood from unrelated donors and were evaluated for hematologic and immunologic reconstitution and GVHD. HLA matching was performed before transplantation by serologic typing for class I HLA antigens and low-resolution molecular typing for class II HLA alleles. In donor-recipient pairs who differed by no more than one HLA antigen or allele, high-resolution class II HLA typing was done retrospectively. For donor-recipient pairs who were mismatched for two HLA antigens or alleles, high-resolution typing was used prospectively to select the best match for HLA-DRB1.Results Twenty-four of the 25 donor-recipient pairs were discordant for one to th ree HCA antigens. In 23 of the 25 transplant recipients, the infused hematopoietic stem cells engrafted. Acute grade III GVHD occurred in 2 of the 21 patients who could be evaluated, and 2 patients had chronic GVHD. In vitro proliferative responses of T cells and B cells to plant mitogens were detected 60 days after transplantation. With a median follow-up of 12 1/2 months and a minimal follow-up of 100 days, the overall 100-day survival rate among these patients was 64 percent, and the overall event-free survival was 48 percent.Conclusions HLA-mismatched placental blood from unrelated donors is an alternative source of stem cells for hematopoietic reconstitution in children. (C) 1996, Massachusetts Medical Society.