The Clinical Characteristics Of Cord Blood Transplantation And Haplo-identical Stem Cell Transplant Supported By Co-infusion Of Cord Blood

Part ⅠThe role of HLAhigh resolution typing in umbilical cord bloodtransplantationObjective To investigate the clinical value of HLA matching(low and high resolution)and their effect on outcomes of patients who received umbilical cord bloodtransplantation(UCB).Methods Sequence-specific oligonucleotide probe (SSOP), sequence-based typing(SBT) and sequence-specific primers(SSP) were used to perform high resolution HLAmatching for HLA-A,-B,-C,-DRB1,-DQB1and low resolution for HLA-A,B,DRB1between25malignant or non-malignant hematologic patients who received unrelated UCBtransplantation and grafts. We examined the effects of HLA matching (low or highresolution) on engraftment of leading, hematopoietic reconstitution, graft-versus-hostdisease (GVHD), infection and2years overall survival after UCB transplantation.Results The median total nucleated cells(TNC) of cord blood transplanted was6.0×107/kg, The percents of neutrophil recoveries, more than5×107/kg TNC was68.7%significantly higher than42%which less than5×107/kg,(P=0.043). The HLA-(6-10)/10group of high resolution HLA matching was better than the HLA (3-5)/10group in therespect of engraftment of leading(P=0.022)and the rate of serious acuteGVHD(P=0.008).In contrast,HLA-I+II locus mismatch could prolong the plateletengraftment time (P=0.017). There was no statistical difference in the time of plateletrecovery, but the rate of serious acute GVHD after UCB transplantation between the HLA (5-6)/6group of low resolution HLA matching and the HLA4/6groupwere6.7%and50%(P=0.033）. the mismatch locus of HLA low resolution has no difference in the time ofplatelet recovery(P>0.05).Conclusions The High resolution HLA matching performed between patients whoreceived unrelated UCB transplantation and grafts contribute to select the better UCB. Ithas important clinical value in promoting hematopoietic reconstitution and reducingcomplications after UCB transplation. PartⅡThe clinical characteristics of haplo-identical stem cell transplantsupported by co-infusion of cord blood: retrospective analysis in a singlecenterObjectiveTo investigate the clinical value and transplant prognosis of haplo-identical stem celltransplantation supported by co-infusion of single cord blood in malignant blood diseases.MethodsFrom Sep.2007to Oct.2013,95patients with malignant blood diseases in our hospitalwho received the combination of an haploidentical stem cell graft and an unrelatedumbilical cord blood unit. Only63patients received an haploidentical stem cell graft.Analysis different factors such as sex, ABO blood group disparity,way of transplantationand et al,whether or not they have an impact on complications and prognosis aftertransplantion.ResultsCamparing with infusion of haploidentical stem cell,the median time of theco-infusion of an unrelated cord blood unit for neutrophil engraftment was13days (10-30days),and for platelet15days (11-102days),.which not indicates statistical difference (P<0.05).Co-infusion group of the cumulative incidence of relapse at3years was22.14%,single-infusion group was26.2%(P=0.381）.The cumulative incidence of grade III-IV acute graft-versus-host disease (GVHD) in co-infusion group was19.5at day+100,single-infusion group was36.4%(P=0.035).The co-infusion group at three years ofoverall survival(OS) was64.3%, disease free survival(DFS) was65.7%andTransplant-related mortality (TRM)19.2%,the single-infusion group of OS was42.9%,DFS was35.2%and TRM was38.8%(P＜0.05）.Conclusionthe co-infusion of an unrelated cord blood unit has an important clinical value inimproving the OS and DFS of haploidentical allogeneic HSCT.and reducing the incidenceof GVHD and TRM.