我国公共脐血库提供的脐血进行单份非血缘脐血移植的临床疗效评价  

Evaluation of clinical efficacy of single-unit unrelated umbilical cord blood transplantation based on umbilical cord blood provided by China＆#39;s public cord blood bank

作　　者：李建军 刘会兰 朱小玉 汤宝林 宋闿迪 郑昌成 耿良权 童娟 张磊 张旭晗 魏伟 陆薇 周峰 吴洁莹 陈强[6] 余亚圣 蒋中法 杨俊晔[9] 孙自敏 

机构地区：[1]安徽医科大学附属省立医院安徽省立医院血液科,合肥230001 [2]广东省脐带血造血干细胞库 [3]上海市脐带血造血干细胞库 [4]北京市脐带血造血干细胞库 [5]广东省脐带血造血干细胞库广州分库 [6]四川省脐带血造血干细胞库 [7]浙江省脐带血造血干细胞库 [8]山东省脐带血造血干细胞库 [9]天津市脐带血造血干细胞库

出　　处：《中华器官移植杂志》2017年第2期84-89,共6页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金项目（81470350）

摘　　要：目的 分析我国公共脐血库提供的脐血用于移植治疗恶性血液病的疗效和安全性,并探讨我国公共脐血库脐血的质量控制体系.方法 回顾性分析2008年5月至2016年12月因恶性血液病接受单份非血缘脐血移植（sUCBT）治疗的409例受者的临床资料,对各脐血库脐血在冷冻前、复苏后的总有核细胞数（TNC）、CD34^＋细胞数、细胞回收率与移植效果进行对比分析.结果 409份脐血分别来自我国7家（8个）公共脐血库.409份脐血TNC在冷冻前、小管复苏后及大袋复苏后的均数分别为18.5×10^8/L、16.34×10^8/L和15.86×10^8/L,小管复苏后及大袋复苏后的TNC数量较冷冻前均显著减少（P=0.000）.小管复苏后和大袋复苏后的TNC平均回收率分别为88.5％和85.9％,各脐血库间回收率的比较,差异均有显著统计学意义（P=0.000）.冷冻前与小管复苏后的CD34^＋细胞数均数分别为11.18×10^6/L和8.68×10^6/L（P=0.000）,小管复苏后CD34^＋细胞的平均回收率为80.75％,各脐血库间的CD34^＋细胞数回收率的差异均有显著统计学意义（P=0.000）.409例受者移植后42 d粒系累积植入率为95.4％,植入时间中位数为17 d（11～38 d）,移植后120 d血小板累积植入率为84.6％,植入时间中位数为36 d（14～93 d）,移植后60 d红系累积植入率为92％,植入时间中位数为22 d（9～60 d）,各脐血库脐血在移植后粒系、血小板和红系累积植入率比较,差异均有统计学意义（P=0.004,P=0.01,P=0.0002）.移植后100 d受者Ⅱ～Ⅳ度和Ⅲ～Ⅳ度急性移植物抗宿主病（aGVHD）发生率分别为28.63％和15.7％,各脐血库脐血在移植后aGVHD发生率的差异均无统计学意义（P=0.809,P=0.68）;409例受者移植后3年白血病复发率为15.89％,总体存活率（OS）为66.7％,无白血病复发存活率（DFS）为59％,无GVHD及白血病复发存活率（GRFS）为54.3％,各脐血库脐血移植后白血病复发率、OS、DFS及GRFS的差异Objective To study the curative efficacy and safety of single-unit umbilical cord blood transplantation （sUCBT） for malignant hematologic diseases,which is provided by China＆#39;s public cord blood bank.Methods We retrospectively analyzed 409 cases of malignant hematologic diseases who accepted myeloablative single-unit unrelated donor UCBT without ATG at our center between May 2008 and December 2016.A comparative analysis was made on the total nuclear cells （TNC） of the umbilical cord blood before freezing and after thawing,the cells of CD34^＋,the recovery rate of cells and the clinical effect of UCBT.Result 409 units of umbilical cord blood used in UCBT respectively came from eight China＆#39;s public cord blood banks.The average TNC of 409 units of umbilical cord blood before freezing and after the tubular recovery were respectively 18.5 ×10^8 and 16.34 ×10^8 （p =0.000）.The average recovery rate of the tubular recovery was 88.5%,and there was significant difference among cord blood banks （P =0.000）.The average TNC of umbilical cord blood before freezing and transfusion were respectively 18.5 ×10^8 and 15.86 ×10^8 （p =0.000）.The average recovery rate of umbilical cord blood transfusion was 85.9%,with the difference being significant among cord blood banks （P =0.000）.The average number of CD34^＋ cells before freezing and after the tubular recovery was 11.18 ×10^6and 8.68 ×10^6 （p =0.000）.The average recovery rate of CD34^＋ cells after the tubular recovery was 80.75 %,with the difference being significant among the cord blood banks （P =0.000）.At 42nd day after UCBT,the cumulative incidence of neutrophil engraftment was 95.4%,and the median time of the engraftment was 17 days （11-38 days）.The cumulative incidence of platelet engraftment at 120th day was 84.6%,and the median time of the engraftment was 36 days （14-93 days）.The cumulative incidence of erythrocyte engraftment at 60th day was 92%,and the median time of engraftment was 22 days （9d-60 days）.Afte

关 键 词：脐血 造血干细胞移植 脐血库 治疗效果 

分 类 号：R457.7[医药卫生—治疗学]