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回复 s02260441 的帖子, I. a2 Y( ?( P. R7 b
. m$ P- S% X1 LPublished in final edited form as:9 n! w! J2 w C1 M: S
Biol Blood Marrow Transplant. 2009 December ; 15(12): 1596–1602. doi:10.1016/j.bbmt.2009.08.009.
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! ~1 i4 u5 N. A6 P2 Z EA “No-wash” Albumin-Dextran Dilution Strategy for Cord Blood3 L" ?4 F2 p7 n/ |
Unit Thaw: High Rate of Engraftment and a Low Incidence of
2 K. d- }, O; R/ j) E7 qSerious Infusion Reactions
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Abstract
! Q3 M$ e4 ]8 C# o- g1 ^; E+ zPreparation of cord blood (CB) units for infusion by albumin-dextran dilution without& t) U+ }7 d6 p. T
centrifugation may be advantageous for adult patients to minimize cell loss and, unlike a bedside' M6 \- |2 ]. p4 X5 H6 l) D. n5 w
thaw, is still conducted in the controlled laboratory environment. Therefore, we studied CB/ A6 h# r5 x3 E! l% b* E
transplantation (CBT) using this technique in 54 consecutive CBT recipients ≥20 kg. Patients5 B% F# ?, b4 y- Q' M( ~' D
[median age 42 years (range 7–66); median weight 71 kg (range 24–109)] were transplanted for, ^/ p# r# F/ k
high-risk hematological malignancies with ablative (n=35) or non-ablative (n=19) conditioning; N2 z2 N0 b% l' i6 _* `+ \
and 4–6/6 human leukocyte antigen (HLA)-matched double unit grafts. One hundred and seven
- R& \4 b& [9 P. C/ i1 xunits were thawed with dilution whereas 1 red blood cell (RBC) replete unit was washed. A 5:1
g, K& q! G1 Y" tdextran 40/ 25% albumin solution was used. RBC depleted units (n=104) were diluted ≥5.5 fold
/ p5 H; A% F1 {) G9 v& u; k[median final volume 200 ml (range 200–500)] whereas RBC replete units (n=3) were diluted ≥4
) J3 {% {9 E1 H+ Ufold [median final volume 400 ml (range 400–535)]. Total nucleated cell (TNC) recovery was( F8 D( N6 a' \$ p0 s
86%; the median infused TNC dose was 2.17 × 107/kg/unit. While 35 patients (65%) had a total of
) ~4 T! f1 b2 P8 @45 infusion reactions (6 nausea, 31 hypertension, 3 pain, 1 rigors/fever, 2 transient hypoxia, 2
3 k/ H4 f3 R' [$ [4 t' \- ~renal impairment) requiring additional therapy, there were no infusion-related serious adverse
/ s q8 A( h3 Z0 kevents, and reactions were not related to DMSO dose/kg. Cumulative incidence of sustained donor, @' ]0 N! u, r. ~/ i. B
engraftment was 94% (95%CI: 87–100) with neutrophil recovery occurring at a median of 25 days
" Q3 O" I3 i4 A, ]/ m* X w(range 13–43) in ablative and 10 days (range 7–36) in non-myeloablative recipients. CB thaw with
- `1 K: w$ ?6 balbumin-dextran dilution reduces unit manipulation, and minimizes cell loss, speeds time to
2 ^/ @+ m4 C5 l; c, ainfusion, is associated with a tolerable infusion reaction profile, and a high rate of sustained
5 `7 S+ k0 \4 F. n# e! @! vengraftment in CBT recipients ≥20 kg.8 w7 C- S2 r( @' Q. Y7 H$ e
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发表于 2014-5-6 12:15
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