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DOI: 10.1055/s-2002-33174
Aktuelle Möglichkeiten der Behandlung mit blutbildenden Stammzellen aus Nabelschnurblut im Kindesalter
Current state of cord blood transplantation in childhoodPublikationsverlauf
Publikationsdatum:
07. August 2002 (online)
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Zusammenfassung
1989 wurde von E. Gluckman über die erfolgreiche Nabelschnurblutransplantation bei einem Jungen mit Fanconi-Anämie berichtet. Seither wurden weltweit über 1500 allogene Nabelschnurbluttransplantationen durchgeführt. Dies ist u. a. durch den Aufbau von öffentlichen Nabelschnurblutbanken ermöglicht worden, die kryokonservierte Nabelschnurblutprodukte unverwandter Spender zur Verfügung stellen. Die Nabelschnurbluttransplantation ist allerdings mit spezifischen Risiken behaftet, die ihren Einsatz bisher einschränken. Hauptproblem ist die limitierte Zellmenge, die mit einer lang andauernden Neutropenie und einem erhöhten Risiko für ein Transplantatversagen einhergeht. Aufgrund dieser Probleme wird bisher nur bei etwa 1 - 2 % aller Stammzelltransplantationen im Kindesalter Nabelschnurblut als Stammzellquelle genutzt. Der große Vorteil der Nabelschnurbluttransplantation ist das niedrige Risiko für eine Transplantat-gegen-Wirt-Erkankung (Graft-versus Host Disease [GvHD]), einer der Hauptursachen für die hohe transplantationsassozierte Morbidität und Mortalität insbesondere bei unverwandten Stammzellspendern. Das geringe GvHD-Risiko wird auf die niedrige Dosis transplantierter T-Zellen und die funktionelle Unreife der neonatalen Lymphozyten zurückgeführt. Weiterer Vorteil der Nabelschnurbluttransplantation ist die rasche Verfügbarkeit des Stammzellprodukts. Basierend auf den Erfahrungen der allogenen Nabelschnurbluttransplantation werden die Indikationen zur „gerichteten” und „ungerichteten” Nabelschnurblutspende diskutiert.
Abstract
In 1989 E. Gluckman reported the successful cord blood transplantation in a boy with Fanconi anemia. Since then more than 1500 allogeneic cord blood transplantations have been performed worldwide. This has been possible because non-profit cord blood banks have been established that provide cryopreserved cord blood products from unrelated donors. However, cord blood transplantation is associated with specific risks that have sofar limited its more widespread use. Its main problem is the limited stem cell dose that is associated with a long aplasia and a high rate of engraftment failure. Therefore, cord blood is used as the stem cell source in only about 1 - 2 % of stem cell transplantations in childhood. The main advantage of cord blood transplantation lies in its low risk for graft-versus-host-disease (GvHD), one of the major causes for posttransplant morbidity and mortality particularily with unrelated stem cell donors. The low risk for GvHD is attributed to the low number of transplanted T cells and their functional immaturity. Another advantage of cord blood transplantation lies in the imediate availability of the cord blood units. Based on the experiences with allogeneic cord blood transplantation the indications for cord blood donation will be discussed.
Schlüsselwörter:
Nabelschnurblut - Stammzelltransplantation - Nabelschnurblutspende
Key words:
Cord blood - Stem cell transplantation - Cord blood donation
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