如何提高脐血移植的植入.ppt

113 patients 111 patients 双份脐血移植后最终只有1份优势脐血植入成功，但是很难预测双份脐血中哪一份会成为优势脐血而成功植入。目前只有1项研究提示CD3+细胞比例（p=0.04）及复苏后CD34细胞活力（p=0.008）和脐血优势植入有关. Double UCB transplants show high rates of engraftment (85–100%) with the median time to neutrophil engraftment ranging from 9 to 33 days depending on the conditioning regimen and/or the use of G-CSF). Interestingly though, NOT a significant difference in the rate of engraftment has been demonstrated between patients receiving one or two CBUs. Blood (2007) 110(8):3064–70 Blood (2010) 116(22):4693–9. Blood (2009) 114(19):4293–9. DOUBLE CORD BLOOD TRANSPLANTATION Eurocord`s recommendations for selection of CBUs for transplantation. When a single CBU (6/6 or 5/6 HLA-matched) does not contain sufficient number of cells (TNC2.5X107/kg upon freezing;2.0X107/kg on thawing), double CBT should be considered, aiming for a combined TNC dose 3.0X107/kg. Even higher doses are recommended if the single CBU is only 4/6 HLA-matched (TNC 3.5X107/kg upon freezing; 2.5X 107 /kg on thawing for malignant disorders; TNC 4.0X107/kg upon freezing; 3.5X107/kg on thawing for non malignant disorders). RochaV, et al. Br JHaematol (2009) 147(2):262–74. CORD BLOOD EXPANSION Analternative approach being used to increase cell dose in UCBT ex-vivo expansion of cord blood. As well as increasing the total number of HSC cells for long-term engraftment, this may also increase the number of committed progenitors to reduce the initial period of neutropenia. Target cell：CD34+,CD133+cells Expansion methods: Cytokines Notch ligand expansion Stromal culture Bioreactors 图1.纯化的UCBCD133+细胞的免疫表型及形态学 Projects Day-6 Day-10 TNC 41.07±9.59 235.66±32.36 CD133+cells 7.98±1.59 15.58±6.04 CD34+cells 18.32±7.98 22.92±7.56 CD34+ CD38-cells 51.10±15.25 91.84±25.64 CD34+ CD133+cells 3.10±1.08 13.56±9.92 Expansion folds of cord blood at day6 and day10 Immunophenotype of expanded cells day-0 day-6 Cytokines cocotail day-10 day-15 97.5% 1.05% 9.27% 15.3% 6.98