Umbilical cord transplantation.
The clinical efficacy of allogeneic bone marrow transplantation has been limited by difficulties in locating HLA-matched donors, and the occurrence of graft failure, severe graft-versus-host disease (GVHD), and opportunistic infections. Placental or umbilical cord blood may overcome some of these problems. Phase I-II trials of umbilical cord blood transplants (UCBT) show an overall engraftment rate of approximately 90%, with a median time to neutrophil recovery of 26 days. Nucleated cell, dose, and CFU-GM and CD34+ content were inversely correlated with the time to neutrophil recovery (P < .01 for each). The overall probability of grade II-IV GVHD was approximately 40%, despite high degrees of HLA disparity between donor and recipient. In analysis of data at two institutions, the only factors predictive of survival were age and cell dose within the context of HLA 0-2 antigen disparities. There was no significant effect of HLA on the likelihood or speed of engraftment, the risk of grade II-IV acute GVHD, or survival. UCBT offers several potential advantages over bone marrow transplants for reconstitution of hematopoiesis, including the shorter interval to transplant, the absence of donor attrition, the absence of harvest complications, and the extremely low risk of cytomegalovirus transmission.
Wagner
J E
JE
University of Minnesota, Minneapolis 55455, USA.
D017321:Clinical Trials, Phase I as Topic; D017322:Clinical Trials, Phase II as Topic; D005312:Fetal Blood / Q000166:cytology*; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000453:epidemiology; D006402:Hematologic Diseases / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D011336:Probability; D015996:Survival Rate