Successful salvage with unrelated umbilical cord blood transplant for Hodgkin's disease relapsed following autologous stem cell transplant.

摘要

Patients with Hodgkin's disease (HD) that is either refractory to standard chemotherapy or relapses after autologous stem cell transplant (SCT) have very poor long-term outcome. Results of allogeneic SCT from HLA-matched siblings in this group of patients have shown that, although transplant-related mortality is high, long-term disease-free survival is still possible, supporting the concept of a graft-versus-HD effect. Unfortunately, many of these patients do not have HLA-matched siblings.Umbilical cord blood (UCB) is now considered an acceptable source of stem cells for adult patients needing allogeneic SCT but without an HLA-matched sibling. The application of UCB transplant to adult patients with hematologic malignancies has rapidly expanded in the last few years, especially after the report of the successful use of hematopoietic stem cells (HSC) pooled from two different units of unrelated UCB that may not necessarily be HLA-matched. UCB transplant is particularly suited for patients needing 'urgent' transplants for refractory disease. Unlike unrelated HSC transplants, in which there is usually a delay in the availability of the HSC for transplant due to the search process and procurement of the HSC, UCB procurement is fast and can usually be accomplished in 2-3 weeks. In addition, the stringent matching criteria needed for unrelated HSC transplants are not as important in UCB transplants. The incidence of graft-versus-host disease (GVHD) is also lower. However, the majority of UCB transplants have been carried out for acute leukemias.