Akraba Dışı Kordon Kanı Kaynaklı Kök Hücre Transplantasyonu Retrospektif Analizi

Ayşe Erol; Demet Kıvanç; Mediha Süleymanoğlu; Fatma Savran Oğuz

Research Article

Retrospective Analysis of Unrelated Cord Blood Derived Stem Cell Transplantation

Year 2020, Volume: 3 Issue: 3, 148 - 156, 05.11.2020

Ayşe Erol Demet Kıvanç Mediha Süleymanoğlu Fatma Savran Oğuz

Abstract

Objective: Cord blood stem cells are used for hematopoietic stem cell transplantation (HSCT) in the treatment of hematological malignant and non-malignant diseases, especially in pediatric patients. In this present study, we aimed to evaluate the retrospective analysis of HLA match and survival between donor and patients who underwent cord blood transplantation through the Istanbul University Faculty of Medicine Bone Marrow Bank. Materials and Methods: In order to research the related factors of umbilical cord blood transplantation in Turkey, 102 cases of umbilical cord blood transplantation performed between 2008 and 2014 were analyzed retrospectively. Cord blood unit search applications were performed through Istanbul University, Istanbul Medical Faculty, Bone Marrow Bank. Results: It was, on average, 45 days between the search request and transplantation (range: 11-113 days). Average age of the patients was 42.48±2.8 (1-192 months), male-to-female ratio was 64/38. The most frequent diseases resulting in transplantation were SCID (n=23), AML (n=13), osteopetrosis (n=10), ALL (n=10) and other diseases. There were 38 (37%) cord blood transplantations with matched HLA-A,-B,-DR; 54 (52%) mismatched for HLA-A or -B antigens; 9 (9%) mismatched for HLA-DR only and 1 (1%) mismatched for HLA-B and -DR antigens. The overall survival rate after HSCT with cord blood was 81.5% (n=31/39). The overall survival rate of the patients with HLA class-I antigens mismatch is 48.1% (26/54), the patients with HLA class- II antigens mismatch was 22.2% (2/9) after the HSCT. Conclusion: In conclusion, we found a significant effect in patients undergoing cord blood transplantation with 6/6 HLA matching on overall survival.

Keywords

Hematopoietic stem cell transplantation, cord blood transplantation, HLA, Transplantation

References

1. Wright-Kanuth M, Smith L. Hematopoietic stem cell transplantation. Clin Lab Sci 2001; 14(2):112–117.
2. Munoz J, Shah N, Rezvani K, Hosing C, Bollard CM, Oran B, et al. Concise Review: Umbilical Cord Blood Transplantation: Past, Present, and Future. Stem Cells Transl Med. 2014;3:1435–43. 3. Gluckman E, Koegler G, Rocha V. Human leukocyte antigen matching in cord blood transplantation. Semin Hematol 2005;42: 85–90.
4. Purtill D, Cooney J, Cannel P, Hermann R, Trimboli F, Carter T, et al. Cord blood transplantation in Western Australia. Internal Medicine Journal Royal Australasian College of Physicians 2011;1008-13.
5. Barker JN, Byam C, Scaradavou A. How I treat: the selection and acquisition of unrelated cord blood grafts. Blood 2011;117(8):2332-9.
6. Keklik F, Üstün, C. Akraba dışı Kordon Kanı Nakilleri: Erişkin Deneyimi. İçinde: Beksaç M, (editör). Hematolog. 6. Ankara: Türk Hematoloji Derneği, 2016:77-90.
7. Gluckman E, Devergie A, Bourdeau-Esperou H, Thierry D, Traineau R, Auerbach A, Broxmeyer HE. Transplantation of umbilical cord blood in Fanconi’s anemia. Nouv Rev Fr Hematol 1990;32(6):423-5.
8. Gluckman E, Broxmeyer HA, Auerbach AD, Fiedman HS, Douglas GW, Devergie A, et al. Hematopoietic reconstitution in a patient with Fanconi’s anemia by means of umbilicalcord blood from an HLA-identical sibling. N Engl J Med. 1989;321(17):1174–8.
9. Karasu G, Yeşilipek MA. Akraba Dışı Kordon Kanı Nakilleri: Pediatri Deneyimi. Hematolog 2016;6:65-71.
10. Topçuoğlu P. Türkiye’de Erişkin Akraba Dışı Kordon Kanı Nakli Deneyimi Erişkin Kordon Kanı Nakli. Hematolog 2016;6:91-100.
11. Keklik-Karadağ F, Yurdakul P, Beksaç M. Kordon kanı bankacılığı ve nakli. Hematolog 2019; 236-45.
12. Yurdakul P, Karadağ Keklik F, Beksaç M. Kordon Kanı Bankacılığı ve Kordon Kanı Nakilleri. Turkiye Klinikleri J Hematol-Special Topics 2018;11(1):60-7.
13. Petrini C. Umbilical cord blood collection, storage and use: ethical issues. Blood Transfus 2010;8(3):139-48.
14. Welte K, Foeken L, Gluckman E, Navarrete C. International exchange of cord blood units: the registry aspects. Bone Marrow Transplantation 2010;45(5): 825–31.
15. Dehn J, Spellman S, Hurley CK, Shaw BE, Barker JN, Burns LJ, et al. Selection of unrelated donors and cord blood units for hematopoietic cell transplantation: guidelines from the NMDP/CIBMTR. Blood 134(12):924-34.
16. Eapen M, Klein JP, Sanz GF, et al; Center for International Blood and Marrow Transplant Research. Effect of donor-recipient HLA matching at HLA A, B, C, and DRB1 on outcomes after umbilical-cord blood transplantation for leukaemia and myelodysplastic syndrome: a retrospective analysis. Lancet Oncol. 2011;12(13):1214-21.
17. Eapen M, Klein JP, Ruggeri A, et al; Center for International Blood and Marrow Transplant Research, Netcord, Eurocord, and the European Group for Blood and Marrow Transplantation. Impact of allele-level HLA matching on outcomes after myeloablative single unit umbilical cord blood transplantation for hematologic malignancy. Blood. 2014;123(1):133-40.
18. Eapen M, Wang T, Veys PA, et al. Allelelevel HLA matching for umbilical cord blood transplantation for non-malignant diseases in children: a retrospective analysis. Lancet Haematol. 2017;4(7):e325-e333.
19. Ruggeri A, Volt F, Locatelli F, Michel G, Heredia CD, Abecasis M, et al. Unrelated Cord Blood Transplantation for Acute Leukemia Diagnosed in the First Year of Life: Outcomes and Risk Factor Analysis. Biol Blood Marrow Transplant 2017;23(1): 96–102.
20. Hayashi H, Volt F, Sanz J, Petersen E, Dhedin N, Hough R, et al. Myeloablative Unrelated Cord Blood Transplantation in Adolescents and Young Adults with Acute Leukemia. Biol Blood Marrow Transplant 2019; 25(12):2438-46.
21. Gluckman E, Ruggeri A, Rocha V, Baudoux E, Boo M, Kurtzberg J, et al. Family-directed umbilical cord blood banking. Haematologica 2011; 96(11):1700-07.
22. Cunha R, Loiseau P, Ruggeri A, Sanz G, Michel G, Paolalori A, et al. Impact of HLA mismatch direction on outcomes after umbilical cord blood transplantation for hematological malignant disorders: a retrospective Eurocord-EBMT analysis. Bone Marrow Transplantation 2014;49: 24–29.
23. Milano F, Gooley T, Wood B, Woolfrey A, Flowers ME, Doney K, et al. Cord-Blood Transplantation in Patients with Minimal Residual Disease. N Engl J Med 2016;375:944-53.
24. Huang X, Guo B, Capitano M, Broxmeyer HE. Past, present, and future efforts to enhance the efficacy of cord blood hematopoietic cell transplantation. F1000Research 2019;8:F1000 Faculty Rev-1833.
25. Taupin P, Transplantation of cord blood stem cells for treating hematologic diseases and strategies to improve engraftment. Therapy 2010;7(6): 703–15.

Akraba Dışı Kordon Kanı Kaynaklı Kök Hücre Transplantasyonu Retrospektif Analizi

Year 2020, Volume: 3 Issue: 3, 148 - 156, 05.11.2020

Ayşe Erol Demet Kıvanç Mediha Süleymanoğlu Fatma Savran Oğuz

Abstract

Amaç: Hematolojik malign ve malign olmayan hastalıkların tedavisinde hematopoietik kok hucre transplantasyonu (HKHT) icin özellikle çocuk hastalarda kordon kanı kok hucreleri uygulanmaktadır. Çalışmamızda İstanbul Tıp Fakültesi Kemik İliği Bankası aracılığı ile kordon kanı transplantasyonu uygulanan alıcı ve vericilerin HLA uyumu ve hastaların sağ kalım açısından retrospektif analizlerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Bu çalışmada 2008 ve 2014 yılları arasında göbek kordon kanı hematopoietik kök hücre kaynağı kullanılarak transplantasyonu gerçekleştirilen 102 vaka, retrospektif olarak analiz edilmiştir. Kordon kanı tarama başvuruları İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Kemik İliği Bankası aracılığı ile gerçekleştirilmiştir. Bulgular: Kordon kanı taramasından transplantasyon işlemine kadar geçen süre ortalama 45 gün (11-113 gün) olmuştur. Hastaların ortalama yaşları 42,48±2,8 ay (1-192 ay), erkek-kadın oranı 64/38'dir. Bu grup içindeki vakaların tanıları SCID (n=23), AML (n=13), osteopetroz (n=10), ALL (n=10) ve diğer hastalıklardır (n=46). Kordon kanı transplantasyonu gerçekleştirilen 102 vakadan (%53), HLA-A veya -B antijen uyumsuzluğu; 9 vakada (%9) HLA-DR uyumsuzluğu, 1 vakada (%1) HLA-B veya -DR antijen uyumsuzluğu varken 38 vakada (%37) HLA -A, -B, -DR lokusları tam uyumlu idi. HKHT'den sonra kordon kanı ile tam uyumlu hastaların genel sağ kalım oranı %81,5 (n=31/38) iken Sınıf-I HLA antijen uyumsuzluğu olan hastaların genel sağ kalım oranı %48,1 (26/54), Sınıf-II HLA antijen uyumsuzluğu olan hastalarınki ise %22,2 (2/9) idi. Sonuç: Çalışmamızda 6/6 HLA uyumlu kordon kanından gerçekleştirilen transplantasyonların hastaların genel sağ kalımı üzerinde önemli etkisi olduğu tespit edilmiştir. Bu bağlamda, özel kordon bankaları dışında, akraba dışı kordon kanı transplantasyonları için resmi kordon kanı bankaları kurulması suretiyle Türkiye'deki kordon kanı transplantasyonu sayısı arttırılabilir.

Keywords

Hematopoietik Kök Hücre, Kordon Kanı, HLA, Transplantasyon

References

1. Wright-Kanuth M, Smith L. Hematopoietic stem cell transplantation. Clin Lab Sci 2001; 14(2):112–117.
2. Munoz J, Shah N, Rezvani K, Hosing C, Bollard CM, Oran B, et al. Concise Review: Umbilical Cord Blood Transplantation: Past, Present, and Future. Stem Cells Transl Med. 2014;3:1435–43. 3. Gluckman E, Koegler G, Rocha V. Human leukocyte antigen matching in cord blood transplantation. Semin Hematol 2005;42: 85–90.
4. Purtill D, Cooney J, Cannel P, Hermann R, Trimboli F, Carter T, et al. Cord blood transplantation in Western Australia. Internal Medicine Journal Royal Australasian College of Physicians 2011;1008-13.
5. Barker JN, Byam C, Scaradavou A. How I treat: the selection and acquisition of unrelated cord blood grafts. Blood 2011;117(8):2332-9.
6. Keklik F, Üstün, C. Akraba dışı Kordon Kanı Nakilleri: Erişkin Deneyimi. İçinde: Beksaç M, (editör). Hematolog. 6. Ankara: Türk Hematoloji Derneği, 2016:77-90.
7. Gluckman E, Devergie A, Bourdeau-Esperou H, Thierry D, Traineau R, Auerbach A, Broxmeyer HE. Transplantation of umbilical cord blood in Fanconi’s anemia. Nouv Rev Fr Hematol 1990;32(6):423-5.
8. Gluckman E, Broxmeyer HA, Auerbach AD, Fiedman HS, Douglas GW, Devergie A, et al. Hematopoietic reconstitution in a patient with Fanconi’s anemia by means of umbilicalcord blood from an HLA-identical sibling. N Engl J Med. 1989;321(17):1174–8.
9. Karasu G, Yeşilipek MA. Akraba Dışı Kordon Kanı Nakilleri: Pediatri Deneyimi. Hematolog 2016;6:65-71.
10. Topçuoğlu P. Türkiye’de Erişkin Akraba Dışı Kordon Kanı Nakli Deneyimi Erişkin Kordon Kanı Nakli. Hematolog 2016;6:91-100.
11. Keklik-Karadağ F, Yurdakul P, Beksaç M. Kordon kanı bankacılığı ve nakli. Hematolog 2019; 236-45.
12. Yurdakul P, Karadağ Keklik F, Beksaç M. Kordon Kanı Bankacılığı ve Kordon Kanı Nakilleri. Turkiye Klinikleri J Hematol-Special Topics 2018;11(1):60-7.
13. Petrini C. Umbilical cord blood collection, storage and use: ethical issues. Blood Transfus 2010;8(3):139-48.
14. Welte K, Foeken L, Gluckman E, Navarrete C. International exchange of cord blood units: the registry aspects. Bone Marrow Transplantation 2010;45(5): 825–31.
15. Dehn J, Spellman S, Hurley CK, Shaw BE, Barker JN, Burns LJ, et al. Selection of unrelated donors and cord blood units for hematopoietic cell transplantation: guidelines from the NMDP/CIBMTR. Blood 134(12):924-34.
16. Eapen M, Klein JP, Sanz GF, et al; Center for International Blood and Marrow Transplant Research. Effect of donor-recipient HLA matching at HLA A, B, C, and DRB1 on outcomes after umbilical-cord blood transplantation for leukaemia and myelodysplastic syndrome: a retrospective analysis. Lancet Oncol. 2011;12(13):1214-21.
17. Eapen M, Klein JP, Ruggeri A, et al; Center for International Blood and Marrow Transplant Research, Netcord, Eurocord, and the European Group for Blood and Marrow Transplantation. Impact of allele-level HLA matching on outcomes after myeloablative single unit umbilical cord blood transplantation for hematologic malignancy. Blood. 2014;123(1):133-40.
18. Eapen M, Wang T, Veys PA, et al. Allelelevel HLA matching for umbilical cord blood transplantation for non-malignant diseases in children: a retrospective analysis. Lancet Haematol. 2017;4(7):e325-e333.
19. Ruggeri A, Volt F, Locatelli F, Michel G, Heredia CD, Abecasis M, et al. Unrelated Cord Blood Transplantation for Acute Leukemia Diagnosed in the First Year of Life: Outcomes and Risk Factor Analysis. Biol Blood Marrow Transplant 2017;23(1): 96–102.
20. Hayashi H, Volt F, Sanz J, Petersen E, Dhedin N, Hough R, et al. Myeloablative Unrelated Cord Blood Transplantation in Adolescents and Young Adults with Acute Leukemia. Biol Blood Marrow Transplant 2019; 25(12):2438-46.
21. Gluckman E, Ruggeri A, Rocha V, Baudoux E, Boo M, Kurtzberg J, et al. Family-directed umbilical cord blood banking. Haematologica 2011; 96(11):1700-07.
22. Cunha R, Loiseau P, Ruggeri A, Sanz G, Michel G, Paolalori A, et al. Impact of HLA mismatch direction on outcomes after umbilical cord blood transplantation for hematological malignant disorders: a retrospective Eurocord-EBMT analysis. Bone Marrow Transplantation 2014;49: 24–29.
23. Milano F, Gooley T, Wood B, Woolfrey A, Flowers ME, Doney K, et al. Cord-Blood Transplantation in Patients with Minimal Residual Disease. N Engl J Med 2016;375:944-53.
24. Huang X, Guo B, Capitano M, Broxmeyer HE. Past, present, and future efforts to enhance the efficacy of cord blood hematopoietic cell transplantation. F1000Research 2019;8:F1000 Faculty Rev-1833.
25. Taupin P, Transplantation of cord blood stem cells for treating hematologic diseases and strategies to improve engraftment. Therapy 2010;7(6): 703–15.

There are 24 citations in total.

Details

Primary Language	Turkish
Subjects	Clinical Sciences
Journal Section	Research Article
Authors	Ayşe Erol Demet Kıvanç 0000-0002-2451-5709 Mediha Süleymanoğlu 0000-0002-1401-4863 Fatma Savran Oğuz 0000-0002-6018-8936
Publication Date	November 5, 2020
Submission Date	September 18, 2020
Published in Issue	Year 2020 Volume: 3 Issue: 3

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MLA	Erol, Ayşe et al. “Akraba Dışı Kordon Kanı Kaynaklı Kök Hücre Transplantasyonu Retrospektif Analizi”. Sağlık Bilimlerinde İleri Araştırmalar Dergisi, vol. 3, no. 3, 2020, pp. 148-56.

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