脐血造血细胞含量与白血病脐血移植疗效分析

目的分析4711份库存脐血造血细胞含量及探讨脐血造血细胞含量与白血病脐血移植疗效的关系。方法分析4711例库存脐血总有核细胞数(TNC)和CD34+细胞数分布情况,探讨不同的造血细胞输入量、供受者HLA不相合数、受者性别、年龄、体重和疾病类型间植入率和生存率的差异。结果 4711例库存脐血TNC和CD34+细胞中位数分别为1.14×109/kg和4.06×106/kg,按3.7×107/kg有效TNC输入量计算,93.2%脐血可供体重50 kg以下受者移植。89例白血病患者移植后植入75例,植入率为84.3%。中性粒细胞绝对值≥0.5×109/L、血小板≥20×109/L和≥50×109/L的时间分别为移植后17、34和46 d。75例植入病例中,长期无病存活47例,死亡26例,2例复发;急性移植物抗宿主病(GVHD)Ⅰ～Ⅱ度、Ⅲ～Ⅳ度和慢性GVHD发生率分别为54.7%、20.0%、9.3%。影响移植植入率的因素包括受者年龄、TNC和CD34+细胞输入量;影响生存率的因素包括受者年龄、体重和输入CD34+细胞数。结论在无法找到HLA全相合骨髓供者时,可选择脐血作为替代骨髓的造血干细胞来源治疗儿童与成人白血病,TNC和CD34+细胞数仍是选择脐血移植物的参考指标。

The relationship between the hematopoietic cell counts of cord blood and the therapeutic effect of umbilical cord blood transplantation in patient with leukemia

Objective To analyze the hematopoietic cell counts in 4711 cord blood unites and explore the relationship between the cell counts and the therapeutic effect of umbilical cord blood transplantation(UCBT).Methods The distribution of total nucleated cells(TNC) and the absolute CD34+ cells counts were analyzed in 4711 cord blood unites.Meanwhile,the differences among hematopoietic cells input,HLA disparity,gender,age,weight,the type of the disease as well as the survival rates were investigated.Results The median counts of TNC and CD34+ cells were 1.14×109 and 4.06×106,respectively;93.2% of frozen cord blood was suitable for the transplantation in the patients with weight less than 50kg;the engraft rate was 84.3%(75/89).Neutrophil cells reconstitution at 0.5×109/L,platelet reconstitution at 20×109/L and 50×109/L occurred at the 17th,34th and 46th days of UCBT,respectively.Among 75 engrafted cases,47 patients got complete remission,26 patients died and 2 patients relapsed.The incidences of acute graft-versus-host disease(GVHD) with gradeⅠ-Ⅱ,Ⅲ-Ⅳ and chronic GVHD were 54.7%,20.0% and 9.3%,respectively.The risk factors of engraftment included age,the counts of TNC and CD34+cells;the overall survival rate was related to the factors including age,weight and the counts of TNC and CD34+cells.Conclusions Umbilical cord blood could be considered as the source of hematopoietic stem cells and used for the transplantation of the childhood and adult patients with leukemia when there is no acceptably matched bone marrow donor.The cell counts of TNC and CD34+ cells are useful reference index for the selection of cord blood in UCBT.