非血缘脐血移植治疗成年人恶性血液病的展望

近年来,非血缘脐血移植(UCBT)治疗成年人恶性血液病取得较多进展.UCBT治疗急性白血病的疗效与单倍体移植、非血缘骨髓移植、外周血干细胞移植的疗效相当,成为治疗恶性血液病的重要选择.单份UCBT的优势在于移植物抗宿主病(GVHD)发生率低且易于控制,保留有较好的移植物抗肿瘤(GVT)效应,并且患者接受治疗后生活质量较好.而UCBT的劣势在于其脐血干细胞数量少(尤其对于成年患者),因此其植入率低、植入较慢、免疫重建慢、移植早期感染发生风险高.改善UCBT的植入率低、免疫重建慢等问题,可以提高UCBT治疗成年人恶性血液病的疗效,丰富造血干细胞移植的供源.本文对今后UCBT治疗成年人恶性血液病,主要在解决UCBT植入问题、免疫重建问题、脐血人类白细胞抗原(HLA)配型等方面进行展望.

Review and outlook on unrelated cord blood transplantation for treatment of malignant hematological diseases in adults

There are currently more and more unrelated cord blood transplants (UCBT) performed in adults patients with hematological malignancy.Umbilical cord blood is an important hematopoietic progenitor cell source for patients.Recent studies showed comparable curative effect among patients of acute leukemia receiving UCBT,haplo-identical hematopoietic stem cell transplantation,unrelated bone marrow transplantation and peripheral blood stem cell transplantation.The advantage of single UCBT has low incidence rate of graft versus host disease (GVHD) and is easy to control.Also,single UCBT maintains better graft versus tumor (GVT) effects and better quality of life.However,the disadvantage of UCBT is that the number of umbilical cord blood is so low and that the engraftment of UCBT is slow,especially in UCBT for adults.The immune reconstitution after UCBT is also slow,and results in early infection after transplantation.Improve engraftment and reconstitute immune system can significantly improve clinical outcomes.In this review,we further advance the usage of UCBT in adult patients with malignant hematological disease,and prospect the methods to enhance hematopoietic stem cell expansion,improve engraftment,reconstitute immune system and select the best human leukocyte antigen (HLA) matching.