| The hematological malignant diseases are the major disordersendangering children's lives. Great success in treating tl1e patientswith hematological malignant disease have been gained withallogeneic bone marrow transplatation (allo-BMT)and allogeneicperipheral blood stem cell transplafltation (allo-PBSCT). Theprincipal limitation of allo-BMT and allo-PBSCT is the lack ofsuitable HLA-matched donors and complications due to graft-vs-host disease (GVHD) that are more severe with increasing HLAmismatches. In addition, the higher probability of ralaPse limitesautologous blood stem cell transplantation (ABSCT). Theadvantages of umbilical cord blood transplantation (UCBT) are thelarge donor pool, faster allocation process, dreased risk of viralX6).gxt?e (2002 )ffi) M5[lty&iftt liiJ)JtaMtheirtl\ffiff8P1As$gh ll 9IJllta&4Rrt,xMM --transn1ission, ai1d low incidence of GVHD due to the hamtllrity oftlle newborn's immtlne system. Compared to Allo-BMTS wllereHLA identity for c1ass I and class II antigens is required,UCBTS can be prefOrmed with donors having one, tWo, or tlireeHLA antigen mislnatcI1es. As tlle tl1ird source of hematopoieticsteIn cell, umbilical cord blood stem cell transplantation isillcreasingly paid cIose attention to. lll tl1is field, our country hasbeeIl laying behind adval1ced co[lntries. It was in our hospital tliatthe first related UCBT in our coulltry was performed successfully totreat a patient with AML-M2 in l998.The aim of this study was to investigate hematopoieticrecovery and immoune reconstitution in related UCBT tl1eincidence and severity of GVHD, and was to find the number ofneeded nucleated cells infused, safe preparative regimen, GVHDprophylaxis and other factors affectillg UCBT.Materials and Methods: ll patients with hematologicalmalignaIlt disease were transplantatioll with umbilical cord blood f 4patients with acute myelocytic leukemia (AML) M2 during the firstcolllplete relnission (CR,), 2 patients with acute lymphocyticleukemia (ALL) (higll risk group) during CR,, l case witl1 ALL(standard-risk 8iroup) dLuing Cl13, l case with acute mixedleukemia during CR,, 2 cases with cl1ronic myelocytic leukemia(AML) during chronic period, 1 case witll Inyelodysplasticsysdrome-refractory anemia (MAS-RA). Median age was l1 yearsold (range 4~16), lnean weigl1t was 34.3kg (rangel5~65). Cord6XV]'l1x$(200z)ai) f)fgt11PMitx laJ8ta)gilatf$tj1/dfIstttham ll 06lha$4Rrt~ x x x -- -- un - x x ~ M w x M x w w -- unblood was collected at the patient's sibling birth, which HLA-A, Bwas defined by serology typing and D;R by PCR/SSP low-resolutiontyping before delivery 9 cases were matched and 2 donors had 2HLA mismatches. 3 cases were major ABO-mistmatCl1ed, 2 caseswere minor ABO-mistmatched and 6 cases were ABO-matched.Tlie preparative regimen consisted of Busulfan (Bu) 4mg/kg/d, X 4d,and Cyclophosphamide (Cy) 60mg/kg/d, X2d. GVHD prophylaxisconsisted of only cyclosporin A (CsA) 2-3mg/kg/d. Mean collectedcord blood was l4l n1l (range 76~208), median number of nucleatedcells (NCs) infused was 3.5 X l0'/Ifg (range l.5~l0.0), mediannumber of CFU-GM infused was 2.57 X l0#/kg (range 0.86~7 .42),lnedian number of CD34 + cells infused was 3.72 X l0'ilig (range0.90~8.33). From-2 days to the time of hematopoietic recoverythe peripheral blood was checked to observe the time to reach>0.5 X l0tyL neutrophils, > l.0 X 109/L neutrOpuns, >0.5 X 109/Llpnphocytes, > l.0X l09/L lyInphocytes, >20X l09/L platelets, and>50 X l09/L platelets every other days. Bone marrow was checkedto observe its proliferation and the chimera of DNA by moniteringmicro-satellite points. CD3, CD4, CD8, CD19, CD56 lymphocytesubsets was checked with Flow Cytology Meterage (FCM) befOre' transplant, at 3 mollthes, l2 monthes post transplant. Tlie data about..ilnmune recovery were indicated by x t s and analyzed withANOVA and processed by SPSSl().0. A statishcally si... |
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