脐血移植在血液系统疾病中的临床应用研究进展

Research Advances on Clinical Application of Umbilical Cord Blood Transplantation in the Treatment of Hematological Diseases--Review

脐血是血液系统疾病患者无HLA相合供体时造血干细胞来源之一。与骨髓、动员后外周血相比,脐血具有易获得、对供体无害、供受体HLA相合要求不高等优势。但脐血中造血干细胞数量一般较少,移植失败风险较大,易导致造血及免疫重建延迟,移植相关死亡率较高。双份脐血是增加脐血中干细胞数量的一种直接简便的方法,与单份脐血相比,双份脐血移植后患者疾病复发率低,移植物抗宿主病发生率较高,但造血重建、受者总体生存率等指标无明显差异。脐血体外扩增新技术的发展使脐血干细胞体外扩增效果更好,单份扩增后脐血移植不仅能增加脐血的来源,而且能减少双份脐血较高的花费。ATG能降低移植失败风险及移植物抗宿主病发病率,但其在脐血移植中的地位仍有争论。本文就近年来脐血移植领域上述几个问题作一综述,以期为临床决策提供参考。

Umbilical cord blood(UCB)is an alternative source of hematopoietic stem cells(HSCs)for patients who were lack of HLA match related or unrelated donors.Compared with bone marrow and mobilized peripheral blood,UCB has the advantages of easy availability,safety for donors,and low requirement for HLA match between donors and recipients.However,the cell amount in UCB is relatively less,which was associated with increased graft failure,delayed hematologic recovery,immune reconstitution,and higher transplant related mortality after UCB transplantation(UCBT).Double-unit UCB is a straightforward method to augment cell amount in UCB.Compared with single-unit UCBT,doubleunit CBT associated with less risk of primary disease relapse and increased incidence rate of graft-versus-host disease(GVHD),but the hematologic recovery and overall survival of recipients were no significantly difference between single and double-unit UCBT.Novel strategies for UCB expansion significantly increased the cell amount in UCB,single-unit expanded UCBT not only increased the sources of UCB,but also decreased the high cost of double-unit UCB.ATG can decrease the risk of graft failure and GVHD rate,but the role of ATG in UCBT is still controversial.Herein,the recent clinical advances on UCBT in the treatment of hematologic diseases are systematically reviewed.