Unrelated Donor Peripheral Blood Stem Cells And Umbilical Cord Mesenchymal Stem Cells Transplantation In Patients With Hematologic Malignancy

Objective: This study was aimed to explore the security,efficiency of transplantation of unrelated donor peripheral blood stem cells(URD-PBSCs)combined with umbilical cord mesenchymal stem cells(UC-MSCs).Methods: We retrospectively evaluated clinical data in 49 cases(32 males,17 females) of unrelated donor peripheral blood stem cells transplantation(URD-PBSCT) with hematologic malignancy from August 2005 to August 2013,including 12 AML,17 ALL,18 CML and 2 MDS. 48 patients received complete remission(CR)and 1 non-remission(NR) before transplantation. Conditioning regimens were Bu+CY+Ara-c or TBI+CY+Ara-c. MMF+CSA+MTX+ATG/ALG were used for graft versus host disease(GVHD) prophylaxis. All donors(35 males, 14 females) were unrelated HLA matching consistency(high resolution with type 8 points or more). Bone marrow was mobilized by G-CSF for 4 days and the peripheral blood stem cells were collected.22 patients received transplantation of URD-PBSCs combined with UC-MSCs and 27 patients received only URD-PBSCT.A median of 8.10(4.76-17.5)×108/kg nucleated cells and 4.25( 1.03-25.27) ×106/kg CD34+ cells were transfused in the UC-MSCs+URD-PBSCT group and a median of 8.15(4.33-21)×108/kg nucleated cells and 7.29(2.31-20)×106/kg CD34+ cells were transfused in the URD-PBSCT group. The average count of re-infusing UC-MSCs was 1.0×106/kg in the UC-MSCs+URD-PBSCT group. Spss statistical software was used to analyze hematopoietic reconstitution, GVHD, TRM, survival time and survival rates and RR between the two groups.Results: The results showed that the transplantation was uneventful.8 conditioning regimens were TBI/CY/Ara-c in the URD-PBSCT group. In addition to one patient in UC-MSCs+URD-PBSCT group died of hepatic venous occlusive disease(HVOD) in the 13 days after transplantation, the sex chromosome and DNA fingerprint detection after one month in the remaining patients showed that the receptors completely received hematopoietic stem cell from donors.The number of neutrophils was over 0.5×109/L during a median recovery period of 12 d in the UC-MSCs+URD-PBSCT group,which was much faster than that in URD-PBSCT group(12d versus 15 d, P=0.041). The incidence of chronic graft versus host disease(c GVHD) was lower in the UC-MSCs+URD-PBSCT group(20.0% versus 51.9%, P=0.026),the same as severe massive c GVHD(5.0% versus 33.3%, P=0.040). However,the incidence of CMV was higher in the UC-MSCs+URD-PBSCT group(81.0% versus 51.9%, P=0.037). In addition to these,no statistical difference was observed for implantation level,the PLT reconstitution,the time of c GVHD,a GVHD,lung infection,hemorrhagic cystitis,1-year relapse and survival,cumulative survival between the two groups(P>0.05). Conclusion: It is concluded that transplantation of URD-PBSCs combined with UC-MSCs is feasible and safe.The speed of neutrophils reconstitution is faster. The incidence and severity of c GVHD is lower,but the attention should be paid to prevent the CMV infection.