Abstract：Objective To evaluate the clinical effect of umbilical cord blood transplantation (UCBT) in children with hematologic malignancies. Methods A retrospective analysis was performed on the clinical data of 37 pediatric patients with hematologic malignancies that consisted of 14 cases of acute lymphocyte leukemia, 9 cases of acute myeloid leukemia, 5 cases of juvenile myelomonocytic leukemia, 3 cases of chronic myeloid leukemia, 2 cases of acute mixed leukemia, 3 cases of myelodysplastic syndrome, and 1 case of lymphosarcomatous leukemia. Thirty-seven children with hematologic malignancies received UCBT from unrelated donors (34 cases) and related donors (3 cases). Grafts were 6/6 HLA-matched in 5 cases, 5/6 HLA-matched in 12 cases, 4/6 HLA-matched in 11 cases, and 3/6 HLAmatched in 9 cases. Before transplantation, these patients received rabbit antithymocyte globulin-containing conditioning regimen. The myeloablative conditioning regimen was given in 36 cases and the reduced-intensity conditioning regimen in one case. The median age of transplantation was 5.7 years, and the median weight was 20 kg. The grafts that contained a median of 6.2×107 total nucleated cells (TNC)/kg and 2.7×105 CD34+ cells/kg were infused. Results The median times to neutrophil engraftment and platelet engraftment were 12 days and 25 days, respectively, and the rates of neutrophil engraftment and platelet engraftment were 95% and 78%, respectively. The rate of neutrophil engraftment was positively correlated with the number of CD34+ cells (P=0.011), while the rate of platelet engraftment was correlated with the numbers of CD34+ cells and TNC (P=0.001; P=0.014). The incidence rates of acute and chronic graft-versushost disease were 49% and 11%, respectively. The median follow-up was 54 months. The 5-year transplant-related mortality, overall survival, and disease-free survival were 27%, 57.4% and 41%, respectively. Conclusions UCBT is an alternative source of hematopoietic stem cells for patients with hematologic malignancies.
Rubinstein P, Carrier C, Scaradavou A, et al. Outcomes among 562 recipients of placental-blood transplants from unrelated donors[J]. N Engl J Med, 1998, 339(22): 1565-1577.
[2]
Gluckman E, Rocha V. Cord blood transplantation for children with acute leukaemia: a Eurocord registry analysis[J]. Blood Cells Mol Dis, 2004, 33(3): 271-273.
Chan RJ, Cooper T, Kratz CP, et al. Juvenile myelomonocytic leukemia: a report from the 2nd International JMML Symposium[J]. Leuk Res, 2009, 33(3): 355-362.
Kurtzberg J, Prasad VK, Carter SL, et al. Results of the Cord Blood Transplantation Study(COBLT):Clinical outcomes of 193 unrelated donor umbilical cord blood transplantation in pediatric patients with malignant conditions[J]. Blood, 2008, 112(10): 4318-4327.
[9]
Diaz MA, Gonzalez-Vicent M, Ramirez M, et al. Allogeneic cord blood transplantation in children with hematological malignancies: a long-term follow-up single-center study[J]. Pediatr Hematol Oncol, 2009, 26(4): 165-174.
[10]
Stevens CE, Carrier C, Carpenter C, et al. HLA mismatch direction in cord blood transplantation: impact on outcome and implications for cord blood unit selection[J]. Blood, 2011, 118(14): 3969-3978.
[11]
Kanda J, Atsuta Y, Wake A, et al. Impact of the Direction of HLA mismatch on transplantation outcomes in single unrelated cord blood transplantation[J]. Biol Blood Marrow Transplant, 2013, 19(2): 247-254.
Sanz J, Boluda JC, Martin C, et al. Single-unit umbilical cord blood transplantation from unrelated donors in patients with hematological malignancy using busulfan, thiotepa, fludarabine and ATG as myeloablative conditioning regimen[J]. Bone Marrow Transplant, 2012, 47(10): 1287-1293.
[14]
Lee SH, Lee MW, Yoo KH, et al. Co-transplantation of third-party umbilical cord blood-derived MSCs promotes engraftment in children undergoing unrelated umbilical cord blood transplantation[J]. Bone Marrow Transplant, 2013, 48(8): 1040-1045.
[15]
Eapen M, Rubinstein P, Zhang MJ, et al. Outcomes of transplantation of unrelated donor umbilical cord blood and bone marrow in children with acute leukaemia: a comparison study[J]. Lancet, 2007, 396(9577): 1947-1954.
[16]
Shi-Xia X, Xian-Hua T, Xiang-Feng T. Unrelated umbilical cord blood transplantation and unrelated bone marrow transplantation in children with hematological disease: a meta-analysis[J]. Pediatr Transplant, 2009, 13(3): 278-284.
Tomonari A, Iseki T, Ooi J, et al. Cytomegalovirus infection following unrelated cord blood transplantation for adult patients: a single institute experience in Japan[J]. Br J Haematol. 2003 121(2): 304-311.
[19]
Merindol N, Salem Fourati I, Brito RM, et al. Reconstitution of protective immune responses against cytomegalovirus and varicella zoster virus does not require disease development in pediatric recipients of umbilical cord blood transplantation[J]. J Immunol, 2012, 189(10): 5016-5028.
[20]
Albano MS, Taylor P, Pass RF, et al. Umbilical cord blood transplantation and cytomegalovirus: posttransplantation infection and donor screening[J]. Blood, 2006, 108(13): 4275-4282.
[21]
Montesinos P, Sanz J, Cantero S, et al. Incidence, risk factors, and outcome of cytomegalovirus infection and disease in patients receiving prophylaxis with oral valganciclovir or intravenous ganciclovir after umbilical cord blood transplantation[J]. Biol Blood Marrow Transplant, 2009, 15(6): 730-740.
[22]
Brown J A, Boussiotis VA. Umbilical cord blood transplantation: basic biology and clinical challenges to immune reconstitution[J]. Clin Immunol, 2008, 127(3): 286-297.
[23]
Ebihara Y, Takahashi S, Mochizukia S, et al. Unrelated cord blood transplantation after myeloablative conditioning regimen in adolescent and young adult patients with hematologic malignancies: a single institute analysis[J]. Leuk Res, 2012, 36(2): 128-131.
[24]
Rocha V, Kabbara N, Ionescu I, et al. Pediatric related and unrelated cord blood transplantation for malignant diseases[J]. Bone Marrow Transplant, 2009, 44(10): 653-659.
[25]
Bradley MB, Satwani P, Baldinger L, et al. Reduced intensity allogeneic umbilical cord blood transplantation in children and adolescent recipients with malignant and non-malignant diseases[J]. Bone Marrow Transplant, 2007, 40(7): 621-631.
[26]
Jeon T Y, Kim JH, Eo H, et al. Post transplantation lymphoproliferative disorder in children: manifestations in hematopoietic cell recipients in comparison with liver recipients[J]. Radiology, 2010, 257(2): 490-497.
[27]
Ramos CA, Saliba RM, de Padua L, et al. Impact of hepatitis C virus seropositivity on survival after allogeneic hematopoietic stem cell transplantation for hematologic malignancies[J]. Haematologica, 2009, 94(2): 249-257.
