ТРАНСПЛАНТАЦИЯ ПУПОВИННОЙ КРОВИ У ДЕТЕЙ: ОБЗОР ЛИТЕРАТУРЫ И ОПЫТ ОДНОГО ЦЕНТРА

Abstract

Umbilical cord blood (CB) has been used successfully as hematopoietic stem cells (HSCs) in adults and adults with malignant and non-malignant diseases in which there are indications for HSC transplantation (HSCT), and when an HLA-compatible related or unrelated donor is not available. CB, like any source of HSC, has certain advantages and disadvantages, which also determine the features of its use in transplantation. The article presents the experience of using CB as a source of HSC in pediatric patients at the Russian Children's Clinical Hospital (RCCH). Materials and methods of research: in a retrospective single-center continuous non-randomized uncontrolled open study includes 16 patients with various malignant diseases and 16 patients with non-malignant diseases, who underwent CB transplantation in the bone marrow transplantation department of the Russian Children's Clinical Hospital from 1997 to 2012. The peak of CB transplant activity occurred in the period from 2006 to 2010. The age of the patients at the time of the transplantation ranged from 6 months to 14 years. In 10 patients, a CB transplant from HLA-identical related donors was used, in 22 – from unrelated HLA-identical and HLA-incompatible for 2 or more antigens obtained from domestic CB banks. In addition to CB, six children were given bone marrow or peripheral blood stem cells from HLA-identical siblings as a transplant. The majority of patients (n=20) received one CB sample, 10 patients – 2 samples and two – 3. Results: implantation of the transplant was recorded in 27 children (84%), which 17 (53%) were alive, 10 (31%) died at different timesof post-transplant period. In 5 (16%) patients, implantation did not occur, of which one (3%) died, the cause of mortality in pediatric patients was a relapse of the underlying diseases. Acute graftversus-host reaction (GVHD) after CB transplantation was assessed in 27 (84%) patients of this study, among them 17 (63%) were diagnosed with acute GVHD stages I-II, 3 (11%) – stage III–IV (life-threatening form). Chronic GVHD was assessed in 18 (56%) patients included in the study, with 5 (28%) diagnosed with a limited form and 3 (17%) with an extensive form. Overall survival (OS) for the entire group of patients (n=32) was 58,3±8,8%, 5-year dormant survival rate (DSR) – 53±8.8%. OS in non-malignant diseases was higher (68%) than for malignant diseases (56%), but no statistically significant differences in OS were obtained in the two groups (p>0,05), as well as when comparing OS and DSR when using one or several samples of CB. Conclusion: CB remains available and acceptable source of stem cells for HSCT. At our center, the survival rates of patients after CB transplantation are comparable to those of international registries. The improvement of the method and the results of haploidentical SCT in recent years has led to a decrease in interest and transplantation activity (including in our center) using CB as a source of HSC. However, the unexplored antileukemic potential of CB stem cells, as well as a number of potential resources for improving and optimizing the use of this HSC source, may increase the chances of future CB transplantation.