25 Jahre Nabelschnurbluttransplantation

J. C. Fischer

doi:10.1055/s-0033-1350911

Transfusionsmedizin, Table of Contents

Transfusionsmedizin 2013; 3(4): 207-220
DOI: 10.1055/s-0033-1350911

CME-Fortbildung

Georg Thieme Verlag KG Stuttgart · New York

25 Jahre Nabelschnurbluttransplantation

J. C. Fischer

Institut für Transplantationsdiagnostik und Zelltherapeutika (ITZ), Universitätsklinikum Düsseldorf

› Author Affiliations

Abstract

Zusammenfassung

Weltweit wird unverwandtes Nabelschnurblut (Cord Blood, CB) zunehmend als Vorläuferzellquelle bei der allogenen hämatopoietischen Stammzelltransplantation (HSCT) verwendet. Mittlerweile sind mehr als 30 000 Patienten allogen mit CB transplantiert worden. Nach zunächst ermutigenden Ergebnissen einzelner Zentren zeigten und zeigen retrospektive Analysen nationaler und internationaler Transplantationsregister sowie zunehmend auch prospektive Studien übereinstimmend, dass die unverwandte CB-(UCB-)HSCT im Vergleich zu HSCT mit anderen Vorläuferzellquellen, wie Knochenmark oder periphere Stammzellen, zwar mit einer verminderten Rückfallrate, aber auch einer erhöhten transplantationsassoziierten Mortalität (TRM) verbunden ist. Dabei hat sich die Überlebensquote nach UCB-HSCT in den vergangenen 10 Jahren deutlich verbessert. Mehrere retrospektive Registerstudien mit einer myeloablativen oder mit einer Konditionierung verminderter Intensität (RIC) haben nach UCB-HSCT ein krankheitsfreies Überleben (EFS) gezeigt, das mit dem nach Transplantation mit Vorläuferzellen eines gewebemerkmal-übereinstimmenden („gematchten“) verwandten oder unverwandten Spenders vergleichbar ist. Wie bei allen HSCT haben der Krankheitsstatus des Patienten und die Erfahrung des Transplantationszentrums einen maßgeblichen Einfluss auf die Ergebnisse der UCB-HSCT. Entscheidend für eine niedrige TRM nach UCB-HSCT ist zudem die Zahl der übertragenen Zellen, und, in zweiter Linie, das Ausmaß der Übereinstimmung der HLA-Gewebemerkmale (HLA: humanes Leukozytenantigen). Verbesserungen in der Auswahl des geeigneten UCB-Transplantats, eine an die UCB-HSCT angepasste Konditionierung des Patienten, Umgang und Manipulation des kryokonservierten Transplantats und Verbesserungen der supportiven Behandlung trugen und tragen zur Verbesserung der UCB-HSCT-Ergebnisse bei. Die zellzahlbedingte Dosisbegrenzung der UCB-HSCT mit einem einzigen UCB-Präparat (Einzel-UCB-HSCT) konnte durch die Einführung der Transplantation mit 2 UCB-Einheiten (Doppel-UCB-HSCT) überwunden werden: Somit können auch größere Kinder und Erwachsenen von der UCB-HSCT profitieren. Der Einsatz dosisreduzierter Konditionierungsschemata hat das Einsatzgebiet der UCB-HSCT auch auf ältere Patientengruppen erweitert, bei denen ansonsten eine Myeloablation zu einer erhöhten TRM führen würde. Die UCB-HSCT kann daher insbesondere für Patienten, bei denen die allogene Stammzelltransplantation infrage kommt und für die in vertretbarer Zeit kein passender verwandter oder unverwandter Spender gefunden werden kann, als Standardmethode zur Transplantation angesehen werden.

Key words

Cord Blood - allogene Stammzelltransplantation - HLA - myeloablative Konditionierung - Konditionierung mit reduzierter Intensität - Doppel-Cord-Blood-Transplantation

Full Text

References

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