RESULTS OF UNRELATED DONOR CORD BLOOD TRANSPLANTATION IN ADULT PATIENTS WITH HEMATOLOGICAL MALIGNANCIES AT SHOWA UNIVERSITY HOSPITAL

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  • 当科における成人造血器腫瘍に対する非血緑者間臍帯血移植の成績
  • 当科〔昭和大学医学部血液内科〕における成人造血器腫瘍に対する非血縁者間臍帯血移植の成績
  • トウ カ ショウワ ダイガク イガクブ ケツエキ ナイカ ニ オケル セイジン ゾウケツキ シュヨウ ニ タイスル ヒケツエンシャ カン サイタイ ケツ イショク ノ セイセキ

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Allogeneic hematopoietic stem cell transplantation is a curative therapy for hematological malignancies. Since the first successful unrelated cord blood transplantation (UCBT) was reported in 1988, umbilical cord blood from unrelated donors has been used as an alternative stem cell source for patients with hematologic disorders. We report the clinical results of UCBT performed at our hospital between August 2003 and April 2005 in 19 adult patients (median age, 42 years ; range, 24-67 years) with hematologic malignancy. The preparative regimens for myeloablative CBT consisted of 12 Gy total body irradiation (TBI) on days - 8 to -6, cytarabine 3 g/m2 every 12 hours on days - 5 and - 4 and cyclophosphamide 60 mg/kg on days - 3 and - 2 and for reduced-intensity CBT (RI-CBT) consisted of 4 Gy TBI on day - 7, f ludarabine 25 mg/kg on days - 6 to - 2 and melphalan 40 mg/kg on days - 3 and - 2. Fifteen patients received cyclosporine (3 mg/kg/day) and short-term methotrexate and 4 patients received FK506 (0.03 mg/kg/day) as prophylaxis against graft versus host disease ( GVHD) . The number of infused nucleated cells was 2.43×107/kg. The median time to >500/μl absolute neutrophil count was 22.6 days, and 8 patients developed grade III to IV acute GVHD. Five of 16 high risk patients remain alive and disease-free after UCBT, and 3 of 5 patients above 50 years of age achieved remission after RI-CBT. These results suggest that UCBT is capable of promoting sustained hematopoietic engraf tment in most adult patients with hematologic malignancy and that it is feasible in high-risk patients. In addition, RI-CBT may become the treatment of choice for young patients with organ failure and for elderly patients.

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