臍血移植與臍帶血庫

Umbilical Cord Blood Transplantation and Cord Blood Banking

10.6440/TZUCMJ.199912.0301

陳年(Nine Chen)；高瑞和(Ruey-Ho Kao)；林俊龍(Chin-Lon Lin)

骨髓移植 ； 臍帶血庫 ； 臍帶血移植 ； bone marrow transplantation ； cord blood bank ； cord blood transplantation

慈濟醫學雜誌

11卷4期（1999 / 12 / 01）

301 - 309

繁體中文

骨髓移植已知為急慢性白血病，再生不良性貧血，骨髓形成不良症候群，遺傳性嚴重免疫缺乏，以及一些生理代謝異常等多種疾病的重要療法。然而，骨髓移植有兩個主要的困難處及限制性，第一就是不易即時尋著HLA配合的損髓者，其次就是移植體後排訴反應的發生。胎盤臍帶血中有造血原細胞。因此先前被視為無臨床用途的臍帶血，目前被認為可作為提供骨髓重建所需之造血幹細胞的選擇之一。自1989年起，美、法等國首先嘗試運用胎盤臍帶血替代骨髓來進行移植，以達到重建骨髓造血機能的目的。而近年來這方面的臨床報告，令人鼓舞，因此臍帶血移植可能對漸成為常規的醫療模式，又因臍帶血移植在作業與療效上在某些方面較傳統骨髓移植為優，似有逐漸取代傳統骨髓移植的趨勢。臍血移植有幾個優點：來源易得，庫存臍血運送方便，移植時在時間上容易掌控，含較多的造血母細胞，收集臍帶血對母體與嬰兒均無影響，帶傳染原(尤其對CMV病毒)的可能性較低，採收臍血比抽取骨髓費用低，移植後排訴反應較低，還可以增加少數族群移植的機會。臍帶血移的缺點：臍帶血量不足(不足夠成人的移植)，臍帶血移植僅有數年的臨來經驗，尚須稍長時日，以觀療效。臍血幹細胞長冷藏之年限沒有確定數據。收集臍血程序，處理與冷藏等作業並不統一，臍帶血庫與臍血之品質處理，尚未訂出標準，社會法律倫理與遺傳病等方面的問題亦尚待解決。 另外，臍帶血除了移植以外，其他醫療用途，如造血幹細胞的培養及體外增殖可以提供很好的研究素材。另外，對於免疫學及基因治療的發展有莫大的助益。世界各地之臨床經驗皆鼓勵臍帶血庫的建立，目前許多先進國家，均已紛紛積極著手建立大小規模的臍帶血庫。滿鄂大約有15,000單位的臍帶血被臍帶血庫儲存，以作為移植應用。可以預期的是，未來五年將可達到總數50,000單位之臍帶血量。這個數糧應可充分的提供非親屬臍帶血移植之需。顯然，臍帶血的建立及臍帶血移植對相關醫療與生命科學的影響可說是相當深遠的，其前景相當光明。(慈濟醫學 1999; 11:301-309)

Bone marrow transplantation is currently an important treatment modality for leukemias, aplastic anemia, hereditary immunodeficiency and some metabolic diseases. However, bone marrow transplantation has two major limiting factors: First, it is not easy to find an Human Lymphocyte Antigen (HLA) matched donor in a timely manner. Second, there is the problem of graft-versus host disease (GVHD). Recently, hematopoietic progenitor cells were found in umbilical cord blood. Thus, placental blood, previously considered a waste product, now constitutes an alternative source of hematopoietic stem cells for bone marrow reconstitution. Since 1989, umbilical cord blood trans-plantation has been tried in place of traditional bone marrow transplantation for marrow reconstitution. Recent clinical experience has been encouraging and cord blood transplantations is tending to become an established treatment modality. The use of placental/cord, in some respects, offers advantages over bone marrow transplantation, so that more and more it has been used in lieu of traditional bone marrow transplantation. Cord blood is readily available, contains a higher concentration of hematopoietic progenitor cells, carries no risk for donors, had very low risk of transmitting infectious diseases (especially cytomegalovirus), is generally less expensive, is associated with a lower incidence of GVHD and offers the opportunity to target ethnic and racial minority groups. However, cord blood transplantation is limited by the small amount of cord blood available (not sufficient for adult patients), it short clinical experience, the long term results not yet being available, the absence of data regarding the effect of long tem storage, the lack of an uniform storage protocol and standardized quality control procedures, and unresolved legal and ethical issues. In addition to cord blood transplantation, the culture and ex-vivo expansion of stem cells from cord blood provide great opportunities for research in the areas of immunology and gene therapy. All these factors have promoted the establishment of cord blood banks around the world. Approximately 15,000 cord blood units are currently stored and available for transplant. It is anticipated that, in the next 5 years, a total of 50,000 units will be reached. This number may be sufficient to provide for the majority of cord blood transplantation procedures. Cord blood transplantation and the establishment of cord blood banks around the world will obviously have a deep impact upon related medical and life sciences.(Tzu Chi Med J 1999; 11:301-309)