title: Placental blood as a source of hematopoietic stem cells for transplantation into unrelated recipients.
abstract: BACKGROUND
  Transplantation of bone marrow from unrelated donors is limited by a lack of HLA-matched donors and the risk of graft-versus-host disease (GVHD). Placental blood from sibling donors can reconstitute hematopoiesis. We report preliminary results of transplantation using partially HLA-mismatched placental blood from unrelated donors.
  
  
  METHODS
  Twenty-five consecutive patients, primarily children, with a variety of malignant and non-malignant conditions received placental blood from unrelated donors and were evaluated for hematologic and immunologic reconstitution and GVHD. HLA matching was performed before transplantation by serologic typing for class I HLA antigens and low-resolution molecular typing for class II HLA alleles. In donor-recipient pairs who differed by no more than one HLA antigen or allele, high-resolution class II HLA typing was done retrospectively. Fordonor-recipient pairs who were mismatched for two HLA antigens or alleles, high-resolution typing was used prospectively to select the best match for HLA-DRB1.
  
  
  RESULTS
  Twenty-four of the 25 donor-recipient pairs were discordant for one to three HLA antigens. In 23 of the 25 transplant recipients, the infused hematopoletic stem cells engrafted. Acute grade III GVHD occurred in 2 of the 21 patients who could be evaluated, and 2 patients had chronic GVHD. In vitro proliferative responses of T cells and B cells to plant mitogens were detected 60 days after transplantation. With a median follow-up of 12 1/2 months and a minimal follow-up of 100 days, the overall 100-day survival rate among these patients was 64 percent, and the overall event-free survival was 48 percent.
  
  
  CONCLUSIONS
  HLA-mismatched placental blood from unrelated donors is an alternative source of stem cells for hematopoietic reconstitution in children.
authors.affiliation: Pediatric Bone Marrow Transplant Program, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: J
authors.initials: J
authors.lastname: Kurtzberg
authors.forename: M
authors.initials: M
authors.lastname: Laughlin
authors.forename: M L
authors.initials: ML
authors.lastname: Graham
authors.forename: C
authors.initials: C
authors.lastname: Smith
authors.forename: J F
authors.initials: JF
authors.lastname: Olson
authors.forename: E C
authors.initials: EC
authors.lastname: Halperin
authors.forename: G
authors.initials: G
authors.lastname: Ciocci
authors.forename: C
authors.initials: C
authors.lastname: Carrier
authors.forename: C E
authors.initials: CE
authors.lastname: Stevens
authors.forename: P
authors.initials: P
authors.lastname: Rubinstein
mesh_terms: D000293:Adolescent; D000328:Adult; D001771:Blood Banks; D001782:Blood Donors; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005312:Fetal Blood / Q000166:cytology / Q000276:immunology; D006086:Graft vs Host Disease / Q000209:etiology; D006680:HLA Antigens / Q000235:genetics; D006402:Hematologic Diseases / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010920:Placenta / Q000098:blood supply; D015996:Survival Rate
chemical_list: D006680:HLA Antigens