Umbilical Cord Blood Stem Cell Transplantation in Korea; Jul. 1996~Jan. 1999

Kim, Hack Ki; Cho, Bin; Han, Hoon; Jeong, Dae Chul; Chung, Nak Gyun; Lee, Hyun Jung; Lee, Young Ho; Kim, Heung Sik; Ahn, Hyo Seop; Kim, Chun Choo

Abstract

PURPOSE: After the first umbilical cord blood transplantation was reported in 1988, the use of cord blood as a source of hematopoietic stem cell instead of allogeneic bone marrow increased surprisingly and currently in the worldwide, more than 1,000 cases of cord blood transplantation were reported. We, herein, report the nine cases of cord blood transplants in Korea (Jul. 1996 - Jan. 1999).
METHODS
The study of childhood cord blood transplantation from July 1996 to January 1999 were analyzed. 1. Patient population 1) Diseases on patients receiving umbilical cord blood transplantation included 3 aplastic anemia (1 Fanconi's anemia), 3 acute myelogenous leukemia, 1 acute lymphoblastic leukemia, 1 chronic myelogenous leukemia and 1 Gaucher disease. 2) Patients included 5 males and 4 females and were aged a range of 1~15 years (median 5 years), and a range of body weight at transplantation was 10 kg~50 kg (median 20 kg). 3) Four cases were used related cord blood as a source of stem cells for the transplant and 5 cases were used unrelated cord blood. In unrelated cord blood transplantation, cord blood was provided by Catholic Cord Blood Bank in 4 cases and by Samsung Medical Center in 1 case. 4) Only one case had a HLA-compatible cord blood graft. Two cases had 1 HLA antigen disparate grafts, 4 cases had 2 HLA antigen disparate grafts and 2 cases had 3 HLA antigen disparate grafts. 2. Transplantation Procedures 1) The total number of nucleated cells infused was 0.2+/-13x107/kg (median number 4.4x107/kg) and the number of CD34+ cells was 0.4+/-9.4x105/kg (median number 3.3x105/kg). 2) Patients received a variety of preparative regimens that varied with the disease and disease state at time of transplantation. All patients received ATG as a part of preparation. 3) While several regimens were used for prophylaxis of GVHD, 3 patients received cyclosporine A and methylprednisolone, 3 patients received cyclosporine and methotrexate, 2 patients received cyclosporine A alone and 1 patients received cyclosporine A, methtrexate and prednisolone.
RESULTS
1. The 6 cases of total 9 cases have successed to engraft persistently and the rate of engraftment was 67%. Two of 3 cases in severe aplastic anemia failed to engraft, 1 case failed to transplant due to rejection of grafts. All 5 cases in leukemia have successed to engraft. 2. On 6 cases of engraftment, the time to achieve an absolute neutrophil count (ANC)> or =0.5x109/L, > or = 1.0x109 /L was 10~37 days (median 13 days) and 11~40 days (median 14 days), respectively, and platelet count > or = 30x109/ L was 15~114 days (19.5 days). 3. Two of evaluable 7 cases had grade II acute GVHD and cured by steroid. 4. Seven of 9 cases (77.8%) survive (2~32 months; median 11 months) after transplantation. Five of 7 surviving cases (55.6%) live with disease-free (2~11 months; median 5 months). Four of 5 patients with leukemia (80%) live without relapse (2~11 months (median 5months). 5. The complications associated with cord blood transplantation were 2 sepsis, 2 CMV infections, 1 hemorrhagic cystitis and venoocclusive disease. 6. Two of 9 patients died of 1 graft failure and 1 venoocclusive disease.
CONCLUSION
Cord blood transplantation is curative strategy for the treatment of children with malignant disease and inborn error of metabolism. For aplastic anemia and myelodysplastic syndrome, the role of cord blood transplantation would be investigated.