Clinical Analysing Of Cases Regarding Unrelated Umbilical Cord Blood Transplantation (UCBT) For The Treatment Of Hemotologic Disease

Objectives1. To explore the feasibility, superiority, indication and the incidence rates of complications regarding UCBT for the treatment of hematologic diseases and find a safe and effective way for the treatment of hematologic diseases in the clinical practice.2. To explore the feasibility, superiority, indication, and the incidence rates complications regarding double-unit UCBT for the treatment of hematologic diseases in order to find a safe and effective way for the treatment of hematologic diseases in the clinical practice.MethodsWe collected the cases from 8 transplantation centers include Jinan military hospital from May, 2001 to December, 2008, including 75 cases in children who received unrelated single-unit UCBT, 25 cases in adults who received unrelated single-unit UCBT and 22 cases who received unrelated double -unit UCBT.1. Analysing 75 children cases which received unrelated UCBT for the treatment of hematologic diseases to explore their hematopoietic recovery situations, the incidence rates of complications such as graft-versus-host disease (GVHD), and clinical treatment effects.2. Analysing 25 adult cases receiving unrelated UCBT for the treatment of hematologic disease to explore their hematopoietic recovery situations, the incidence rates of complications such as GVHD, and clinical treatment effects.3. Analysing 22 cases in which the patients received unrelated double-unit UCBT to explore their hematopoietic recovery situations, the incidence rates of complications such as GVHD, and clinical treatment effects.4. Comparing the treatment efficiency and the incidence rates of complications between single-unit UCBT and double-unit UCBT.Results1. Hematopoietic recovery situations: In 75 children cases which received single-unit UCBT, the medium time of ANC≧0.5×10~9/L was 15(8-74)d, the medium time of PLT≧20×10~9/L was 35(9-99)d; In 25 adult cases receiving single-unit UCBT, the medium time of ANC≧0.5×10~9/L was 22(10-83)d, the medium time of PLT≧20×10~9/L was 42(13-88)d; In 22 adult cases which received double-unit UCBT, the medium time of ANC≧ 0.5×10~9/L was 21(13-67)d, the medium time of PLT≧20×10~9/L was 36(23-57)d. Hematopoietic recovery of children was earlier than that of adult. There were no significant differences in the hematopoietic recovery situations between single-unit UCBT and double-unit UCBT.2. Implantation situations: In 75 children cases which received single-unit UCBT, 48 cases (64%) were implanted, the implantation rate of AA was lower visibly (P<0.05), there were no differences between HLA completely matched and HLA not completely matched between donors and receivers; In 25 adult cases receiving single-unit UCBT, 14 cases (56%) were implanted, and no differences were found in the implantation rates between high risk group and low risk group of malignant hematologic diseases inclued 25 adult cases, the relapse rates of high risk group was higher than low risk group; In 22 adult cases which received double-unit UCBT, 17 cases (77.3%) were implanted, the implantation rate of ALL was lower than other malignant hematologic diseases(P<0.05). There were no differences in the implantation rates between children and adult cases which received single-unit UCBT, the implantation rate of double-unit UCBT was higher than single-unit UCBT(P<0.05). The implantation rate of AA was lower than other hematologic diseases(P<0.05). The implantation rate of ALL was lower than other malignant hematologic diseases(P<0.05).3. graft-versus-host disease(GVHD): In 75 children cases which received single-unit UCBT, 40 cases developed aGVHD, the accumulative incidence rates ofⅠ-Ⅳdegree andⅢ-Ⅳdegree were 53.3% and 6.67%, respectively,3 cases developed cGVHD and the incidence rate was 4%; In 25 adult cases receiving single-unit UCBT, 11 cases developed aGVHD, the accumulative incidence rates ofⅠ-Ⅳdegree andⅢ-Ⅳdegree were 44.0% and 12.0%, respectively, 1 cases developed cGVHD and the incidence rate was 4.0%; In 22 adult cases receiving double-unit UCBT, 13 cases developed aGVHD, the accumulative incidence rates ofⅠ-Ⅳdegree andⅢ-Ⅳdegree were 59.0% and 18.2%, respectively, 1 cases developed cGVHD and the incidence rate was 4.5%. There were no differences in the accumulative incidence rates ofⅠ-Ⅳdegree of GVHD between children and adult cases receiving single-unit UCBT, and the incidence rate ofⅢ-Ⅳdegree of GVHD of children was lower than that of adult. There were no differences in the accumulative incidence rates ofⅠ-Ⅳdegree andⅢ-Ⅳdegree of GVHD between single-unit UCBT and double-unit UCBT.4. Incidence rates of infection: In 75 children cases which received single-unit UCBT, 52 cases developed infection, 14 cases developed invasive infections with fungi(18.67%), 13 cases developed infections with CMV (17.3%); In 25 adult cases receiving single-unit UCBT, 16 cases developed infection, 6 cases developed invasive infections with fungi(24%), 3 cases developed infections with CMV (12%); In 22 adult cases which received double-unit UCBT, 4 cases developed invasive infections with fungi(18.2%),4 cases developed infections with CMV(18.2%). There were no significant differences in the incidence rates of infection between children and adult cases receiving single-unit UCBT, the incidence rate of infection in double-unit UCBT was lower than that in single-unit UCBT(P<0.05). The incidence rate of infection of AA was higher than other hematologic diseases(P<0.05).Conclusions1. Hematopoietic recovery of children cases which received single-unit UCBT was earlier; the incidence rate of infection in children cases receiving single-unit UCBT was higher; the degree of HLA matched between donors and receivers did not effect the implantation rate of children cases; the implantation rate of AA was low, cord blood had sustain effectiveness in hematopoietic recovery; GVHD, morbid state and infections with CMV were correlated.2. Hematopoietic recovery was later, the implantation rate was lower and the relapse rate was higher in adult cases receiving single-unit UCBT; incidence rate of invasive infections with fungi was relatively higher and the incidence rate of GVHD was relatively lower of adult cases which received single-unit UCBT; mesenchyme stell cell help hemopoietic stem cell implanted.3. The double-unit UCBT is feasible for the treatment of hematologic diseases; hematopoietic recovery was relatively earlier and the incidence rate of infection was lower in cases which received double-unit UCBT; one cord blood was implanted and the other was repelled in patients who received double-unit UCBT.4. Hematopoietic recovery of children cases in which the patients received single-unit UCBT was earlier than that of adult, there were no differences of hematopoietic recovery between single-unit UCBT treatment and double-unit UCBT treatment; hematopoietic recovery had positive correlation with total number of mononuclearcell; the implantation rates of ALL was low; there were no significant differences in the incidence rates of GVHD between single-unit UCBT and double-unit UCBT.