Immune recovery in pediatric transplantation: Can T cell-depleted peripheral blood stem cell transplantation beat cord blood transplantation?

摘要

The beginning of the 21st century has been a time of change in stem cell transplantation (SCT) practice, particularly in terms of donor selection for pediatric patients. We have witnessed a decline in peripheral blood SCT (PBSCT) in favor of bone marrow (BM) as a donor source, leading to less graft-versus-host disease (GVHD) [1 ]. With the acquisition of a critical pool of more than 12 million unrelated donors worldwide, this adult stem cell source has achieved some stability in terms of donor availability [2]. However, umbilical cord blood transplantation (CBT) has seen growing acceptance as a ready stem cell source with a low risk for GVHD even with donor-recipient mismatch. The perfection of CBT selection criteria along with concurrent improvements in the quality of cord blood products has produced continuing improvements in transplantation outcomes [3]. Successful new transplantation approaches with related haploidentical SCT promise to again reset the criteria for donor source selection [4]. The article by Oshrine et al [5] in this issue of The Journal opens up a further strategy, using partially T cell-depleted (TCD) PBSCT as an alternative to CBT, especially in mismatched SCT.