Hematopoietic engraftment and survival in adult recipients of umbilical-cord blood from unrelated donors.
Hematopoietic engraftment and survival in adult recipients of umbilical-cord blood from unrelated donors.
复制标题
DOI：
10.1056/nejm200106143442402
复制
发表时间：
2001-06-14
影响因子：
158.5
通讯作者：
Kurtzberg, J
中科院分区：
文献类型：
--
作者：
Laughlin, MJ;Barker, J;Kurtzberg, J
背景资料：来自与受者HLA不完全相同的无关供体的脐带血可以恢复儿童清髓治疗后的造血功能。我们研究了使用脐带血移植，以恢复造血在adultes.Methods：68名成年人与危及生命的血液系统疾病接受强化化疗或全身照射，然后移植HLA不匹配的脐带血。我们评估的结果在血液重建，急性和慢性移植物抗宿主病（GVHD），复发的发生，和无事件的survival.Results：在68例患者中，48（71%）收到移植的脐带血是两个或两个以上的HLA抗原不匹配。在移植后存活28天或更长时间的60例患者中，55例中性粒细胞植入的中位数为27天（范围为13至59天）。68例患者中性粒细胞恢复的估计概率为0.90（95%置信区间为0.85 - 1.0）。脐带血冷冻前有核细胞数量相对较高，与中性粒细胞恢复较快有关。严重的急性GVHD（III级或IV级）发生在55例患者中的11例，这些患者可以在移植后的前100天内进行评估。移植后存活超过100天的33例患者中有12例发生慢性GVHD。存活者的中位随访时间为22个月（范围：11 - 51）。在68名患者中，19名存活，其中18名（26%）在移植后40个月无病。移植物中大量CD 34+细胞的存在与无事件生存率的改善相关（P = 0.05）。结论：无关供体的脐带血可以恢复接受清髓治疗的成人的造血功能，并与严重急性和慢性GVHD的可接受率相关。（N Engl J Med 2001;344：1815-22.）版权所有（C）2001马萨诸塞州医学会。
Background: Umbilical-cord blood from unrelated donors who are not HLA-identical with the recipients can restore hematopoiesis after myeloablative therapy in children. We studied the use of transplantation of umbilical-cord blood to restore hematopoiesis in adults.Methods: Sixty-eight adults with life-threatening hematologic disorders received intensive chemotherapy or total-body irradiation and then transplants of HLA-mismatched umbilical-cord blood. We evaluated the outcomes in terms of hematologic reconstitution, the occurrence of acute and chronic graft-versus-host disease (GVHD), relapses, and event-free survival.Results: Of the 68 patients, 48 (71 percent) received grafts of umbilical-cord blood that were mismatched for two or more HLA antigens. Of the 60 patients who survived 28 days or more after transplantation, 55 had neutrophil engraftment at a median of 27 days (range, 13 to 59). The estimated probability of neutrophil recovery in the 68 patients was 0.90 (95 percent confidence interval, 0.85 to 1.0). The presence of a relatively high number of nucleated cells in the umbilical-cord blood before it was frozen was associated with faster recovery of neutrophils. Severe acute GVHD (of grade III or IV) occurred in 11 of 55 patients who could be evaluated within the first 100 days after transplantation. Chronic GVHD developed in 12 of 33 patients who survived for more than 100 days after transplantation. The median follow-up for survivors was 22 months (range, 11 to 51). Of the 68 patients, 19 were alive and 18 of these (26 percent) were disease-free 40 months after transplantation. The presence of a high number of CD34+ cells in the graft was associated with improved event-free survival (P = 0.05).Conclusions: Umbilical-cord blood from unrelated donors can restore hematopoiesis in adults who receive myeloablative therapy and is associated with acceptable rates of severe acute and chronic GVHD. (N Engl J Med 2001;344:1815-22.) Copyright (C) 2001 Massachusetts Medical Society.