Outcome of related and unrelated cord-blood Transplantation in children at Hematopoietic Stem Cell Transplantation Research Center of Shariati Hospital

Abstract

Introduction:In 1989, the first successful umbilical cord blood transplantations (UCBTs) was reported in a boy with fanconi's anemia, using umbilical cord (UCB) of his HLA matched sister. Cord blood transplantation is a good substitute for bone marrow or peripheral blood transplantation especially for children and small body size adults.
Methods: Between 1998 and 2007 ,14 children(10 boys and 4 girls ) with non-malignant(9 Beta-Thalassemia Major ,3 SCID,1 Hurler) and malignant(1 AML) diseases were given  an allogenic CB transplant from sibling (10 cases) or unrelated(4 cases). In the majority of cases, busulfan and cyclophosphamide were given in various dosage in conditioning regimen GVHD prophylaxis consisted mainly of (CsA) alone(  in 9 cases), the combination of CsA and methoterxate  (in 4 cases)and methotrexate alone (in 1 case).
Results: In thalassemic patients 89% are alive but 55% with disease. Graft failure occurred in 4 thalassemic and 1 AML patients. Only 2 cases experienced GVHD (1 acute GVHD grade2 and 1limited chronic GVHD). All three cases of SCID that transplanted very late after many infectious complications are dead.
Conclusion: This study demonstrated that CBT is curative in   some thalassemic patients but in future, we can improve results of CBT with use of ATG, Alemtuzumab, Thiotepa, G-CSF, double cord, TNC dose of 4×107/kg and elimination of methotrexate  for GVHD prophylaxis in HLA- match sibling.