The dose of CD34+ cells is known to influence the outcome of allogeneic peripheral blood stem cell (PBSC) and/or T-cell-depleted transplantation. A previous study proposed that 2×10⁶ CD34+ cells/kg is the ideal minimum dose for allogeneic transplantation, although lower doses did not preclude successful therapy. In the case we present here, CD34+ cells were collected from a matched sibling donor on the day of allogeneic hematopoietic stem cell transplantation; however, the number of cells was not sufficient for transplantation. Consequently, PBSCs were collected three additional times and were infused along with cord blood cells from the donor that were cryopreserved at birth. The cumulative dose of total nuclear cells and CD34+ cells was 15.9×10⁸ cells/kg and 0.95×10⁶ cells/kg, respectively. White blood cells from this patient were engrafted on day 12. In summary, we report successful engraftment after infusion of multiple low doses of CD34+ cells in a patient with severe aplastic anemia.
Anemia, Aplastic ; Cord Blood Stem Cell Transplantation ; Fetal Blood ; Hematopoietic Stem Cell Transplantation ; Humans ; Leukocytes ; Parturition ; Peripheral Blood Stem Cell Transplantation ; Siblings ; Stem Cells ; Tissue Donors ; Transplantation, Homologous

The purpose of hematopoietic stem cell transplantation by intra-bone marrow injection (IBM-HSCT) is to facilitate the homing of HSC. It has been recently proven in many animal experiments that different kinds of donor cells could efficiently home and engraft into the bone marrow by IBM-HSCT, which led to the rapid hemopoietic and immune recovery of recipients, preventing the development of GVHD, inducing the donor-specific tolerance in allogeneic organ transplantation, and promoting the survival rate of recipients. In this review, the effect of IBM-BMT and IBM-UCBT, the application of IBM injection technique in the study on HSC's biological characteristics, and its prospect for clinical HSCT were summarized.
Animals ; Bone Marrow ; Cord Blood Stem Cell Transplantation ; methods ; Hematopoietic Stem Cell Transplantation ; methods ; Humans ; Infusions, Intraosseous ; Peripheral Blood Stem Cell Transplantation ; methods

This study was purposed to explore the effectiveness of mixed transplantation of HLA mismatched bone marrow hematopoietic stem cells(HSC), peripheral blood HSC and umbilical cord blood HSC for treatment of pediatric blood diseases. From August 2012 to December 2012, five children with refractory hematological diseases in our hospital received allogeneic hematopoietic stem cell transplantation. The mixed grafts consisting of HLA-mismatched bone marrow HSC, peripheral blood HSC and umbilical cord blood HSC were used to observe the effects of umbilical cord blood HSC on the time of hematopoietic reconstruction of bone marrow, STR chimeric degrees, incidence of GVHD. and early transplant-associated complications. The results showed that all 5 children patients were grafted successfully with the median grafted time of 11 d for ANC>0.5×10(9)/L and 10 d for Plt>20×10(9)/L, respectively. On day 30, the STR-PCR test of peripheral blood showed a stable complete chimera. Five cases suffered from mild to moderate symptoms of GVHD, showing with I-II grade of skin GVHD and in which two cases suffered from diarrhea, showing I-II grade of intestinal GVHD. All the 5 patients had no liver function damage. One patient died of severe hemorrhagic cystitis and multi-site infection, and the remaining four cases survived so far on the current median follow-up time of 137 d (130 d-250 d). It is concluded that transplantation of the mixed HLA mismatched bone marrow HSC, peripheral blood HSC, with third-party cord blood HSC can increase the survival rate for pediatric patients with blood disease.
Child ; Cord Blood Stem Cell Transplantation ; Female ; Hematologic Diseases ; therapy ; Hematopoietic Stem Cell Transplantation ; methods ; Histocompatibility Testing ; Humans ; Male ; Peripheral Blood Stem Cell Transplantation ; Treatment Outcome

This study was aimed to investigate the curative effect and safety of human umbilical cord mesenchymal stem cells (hUCMSC) to treat acute graft-versus-host disease (aGVHD) of children after hematopoietic stem cell transplantation (HSCT). HUCMSC were isolated and cultured by collagenase digestion and passage culture. The 3rd to the 5th passage of hUCMSC were used for clinical treatment. Five cases of children acute leukemia achieved complete remission after chemotherapy. Two cases received HLA 3/6 loci matched haploidentical bone marrow HSCT. One case received HLA-matched sibling bone marrow and peripheral blood HSCT. One case received unrelated HLA 4/6 loci matched umbilical cord blood HSCT. One case received unrelated HLA 5/6 loci matched umbilical cord blood HSCT. The children received immunosuppressive therapy after III-IV aGVHD occurring. They received 0.5×10(6)/kg hUCMSC infusion when conventional therapy was ineffective. The results showed that 5 cases of children acute leukemia achieved hematopoietic reconstitution and developed the III-IV grade aGVHD. The five cases of children were infused with hUCMSC. The rash subsided, the liver function was normalized and the gastrointestinal symptoms were improved. The infusion-related adverse reaction did not happen. At present, the 5 children are in remission. It is concluded that allogeneic HSCT is an effective therapeutic method for children with acute leukemia. HUCMSC infusion can be safely and effectively used for the treatment of refractory aGVHD.
Child ; Child, Preschool ; Cord Blood Stem Cell Transplantation ; Female ; Graft vs Host Disease ; therapy ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Male ; Mesenchymal Stem Cell Transplantation ; Treatment Outcome

This study was purposed to investigate the efficacy and safety of haploidentical hematopoietic stem cells (allo-HSCT) transplantation combined with human umbilical cord-derived mesenchymal stem cell infusion (hUC-MSC) for severe aplastic anemia-II (SAA-II). Eight SAA-II patients received haploidentical allo-HSCT, the G-CSF mobilized peripheral hematopoietic stem cells and bone marrow haploidentical hematopoietic stem cells were selected as graft, the human umbilical cord-derived mesenchymal stem cells (hUC-MSC) were infused as the third party. Conditioning regimen consisted of rabbit anti-thymic lymphocytes protein(ATG), cyclophosphamide(CTX) and fludarabine(Flu). For two patients out of 8 SAA-II patients the conditioning regimen was combined with busulfan(BU). The graft versus host disease(GVHD) was prevented with CSA, MTX, ATG, CD25 and mycophenolate mofetil. The results showed that the average number of nucleated cells were 9.13×10(8)/kg, and number of CD34(+)cells were 3.76×10(6)/ kg. All the 8 SAA-II patients achieved hematopoietic reconstitution. The average time of neutrophils count>0.5×10(9)/L was 11.9 days, and average time of Plt level >20×10(9)/L was 14.6 days. The incidence of acute GVHD of I-II grade was 25%, and that of III-IVgrade was 12.5%, the transplantation-related mortality was 25%. It is concluded that haploidentical allo-HSCT combined with umbilical cord MSC infusion is an effective approach to cure SAA.
Adolescent ; Adult ; Anemia, Aplastic ; therapy ; Child ; Cord Blood Stem Cell Transplantation ; Female ; Hematopoietic Stem Cell Transplantation ; methods ; Humans ; Male ; Mesenchymal Stem Cell Transplantation ; Middle Aged ; Transplantation Conditioning ; methods ; Transplantation, Homologous ; Young Adult

This paper summarizes the current literature on the potential therapeutic role of stem cell transplantation for kidney injury and repair and focuses on the choice of types of stem cells, the method of transplantation, and the mechanisms of stem cell homing to injured renal tissues and its protective effects. The application of umbilical cord mesenchymal stem cells (UC-MSCs) shows wide prospects, but the approach and optimal dose of cell transplantation are under intensive investigation. Signals that regulate stem cell homing to injured renal tissues may be related to chemokines or factors released in the target site. Several studies have pointed out that paracrine and endocrine of stem cells are the most likely mechanism of action in the injured nephron. Many questions remain unanswered but stem cell-based therapy is a promising new strategy for acute and chronic kidney diseases.
Animals ; Cord Blood Stem Cell Transplantation ; Humans ; Kidney Diseases ; therapy ; Mesenchymal Stem Cell Transplantation ; Stem Cell Transplantation ; methods

Objective: To explore the clinical efficacy and safety of unrelated umbilical cord blood transplantation (UCBT) in the treatment of refractory and relapsed acute leukemia (AL) patients. Methods: The clinical data of 22 refractory and relapsed AL patients who were treated with UCBT as salvage therapy from November 2009 to May 2017 were retrospectively analyzed. All patients received a myeloablative conditioning regimen for prevention of graft-versus-host disease (GVHD) with cyclosporine A (CSA)/short course of mycophenolate mofetil (MMF). Results: ①Of 22 patients, 9 cases were male and 13 female. The median age was 23 (15-44) years and median weight of 52.5 (43-82) kg. All patients were transplanted with a median umbilical cord blood nucleated cells of 3.07 (1.71-5.30)×10⁷/kg (by weight), the median CD34⁺ cells was 1.60 (0.63-3.04)×10⁵/kg (by weight). ②The myeloid cumulative implantation rate was 95.5% (95%CI 45.2-99.7%) after transplantation of 42 d, with the median implantation time of 19 (13-27) d. The platelet cumulative implantation rate after transplantation of 120 d was 81.8% (95%CI 54.2-93.6%), the median implantation time of 42 (20-164) d. ③The incidence of Ⅱ-Ⅳ, Ⅲ-Ⅳ aGVHD and the 2 year cumulative incidence of cGVHD were 36.4%, 13.6% and 40.3% respectively. ④ The transplant related mortality (TRM) after transplantation of 180d was 22.7%, 2 year cumulative rate of relapse was 18.7% (95%CI 3.6-42.5%), 2 year disease-free survival rate (DFS) and overall survival rate (OS) were 53.7% and 58.1%, respectively. Conclusion: The preliminary results show that the use of UCBT is safe and effective for refractory and relapsed AL patients who fail to respond to conventional chemotherapy.
Acute Disease ; Adolescent ; Adult ; Cord Blood Stem Cell Transplantation ; Female ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Humans ; Leukemia/therapy* ; Male ; Peripheral Blood Stem Cell Transplantation ; Retrospective Studies ; Transplantation Conditioning ; Young Adult

This study was purposed to analyse the clinical efficacy of transplantation of umbilical cord mesenchymal stem cells (UC-MSC) combined with haploidentical hematopoietic stem cells (haplo-HSCT) for patients with refractory/relapsed myeloid leukemia. The clinical data of 36 patients received transplantation of UC-MSC combined with haplo-HSCT from January 2007 to June 2013 were summarized retrospectively, the engraftment, GVHD and 2 years-overall survival (OS) were analysed. The results showed that the median times of neutrophil count>0.50×10(9)/L and platelet count>20×10(9)/L were 12.0 days and 14.0 days, respectively. Grade III to IV aGVHD occurred in 5 out of 36 patients (13.8%). cGVHD occurred in 12 out of 32 patients (37.5%) and extensive cGVHD occurred in 2 patients. Additionally, only 3 patients (8.3%) experienced relapse. The 2-year OS rate of patients was 76.9%. It is concluded that the transplantation of UC-MSC combined with haplo-HSCT has good therapeutic efficacy for patients with refractory/relapsed myeloid leukemia, and may be served as a therapeutic method especially for patients with high risk and without well matched donor.
Adolescent ; Adult ; Child ; Child, Preschool ; Cord Blood Stem Cell Transplantation ; Female ; Hematopoietic Stem Cell Transplantation ; Humans ; Leukemia, Myeloid ; therapy ; Male ; Mesenchymal Stem Cell Transplantation ; Middle Aged ; Retrospective Studies ; Transplantation, Homologous ; Treatment Outcome ; Young Adult

OBJECTIVETo explore the safety and efficiency of unrelated donor peripheral blood stem cells (URD-PBSC) transplantation combined with umbilical cord mesenchymal stem cells (UC-MSC).

METHODSThe clinical data of 49 patients received unrelated donor peripheral blood stem cells transplantation (URD-PBSCT) for treating hematologic malignancies were retrospectively evaluated, including 12 ANLL, 17 ALL, 18 CML and 2 MDS. Out of them, 22 patients received the URD-PBSCT combined with UC-MSC and 27 patients received only URD-PBSCT. The average number of infusing UC-MSC was 1.0 × 10⁶/kg in the UC-MSC+URD-PBSCT group.

RESULTSAs compared with URD-PBSCT group, in UC-MSC+URD-PBSCT group the median recovery time of neutrophilc granulocytes was shorter (12 d vs 15 d) (P = 0.041), the incidence and severity of chronic graft versus host disease (cGVHD) were lower (20.0% vs 51.9%) (P = 0.026) (5.0% vs 33.3%) (P = 0.040), the incidence of CMV infection after transplantation was higher (81.8% vs 51.9%) (P = 0.028). In addition to these, the differences were not statistically significant in term of implantation level, PLT reconstitution, aGVHD, lung infection, hemorrhagic cystitis, 1-year relapse and survival between the 2 groups (P > 0.05).

CONCLUSIONThe transplantation of URD-PBSC combined with UC-MSC is effective and safe. The speed of neutrophils reconstitution is faster. The incidence and severity of cGVHD are lower, but the attention should be paid to prevent the CMV infection.

Cytomegalovirus Infections ; Graft vs Host Disease ; Hematologic Neoplasms ; therapy ; Humans ; Incidence ; Mesenchymal Stem Cell Transplantation ; Neoplasm Recurrence, Local ; Peripheral Blood Stem Cell Transplantation ; Retrospective Studies ; Umbilical Cord ; cytology ; Unrelated Donors

PURPOSE: We compared the clinical outcomes of allogeneic bone marrow transplantation (BM), peripheral blood stem cell transplantation (PB) and cord blood stem cell transplantation (CB) in children with malignant and non-malignant diseases. METHODS: We retrospectively analysed the engraftment speed, episodes of infection, acute graft versus host disease (GVHD), and survival rate in 27 children who underwent hematopoietic stem cell transplantation (HSCT) at Dong-A Cancer Center from August 1998 to July 2001. RESULTS: HSCT were done with BM in 16 patients, CB in 6 and PB in 5. The neutrophil and platelet engraftment were achieved at 13.27+/-4.10, 24.58+/-9.41 days in BM, 12.00+/-1.09, 15.88+/-4.42 days in PB, and 39.00+/-15.68, 76.50+/-37.01 days in CB (P=0.001, P=0.001). There were 17 episodes of bacteremia and 10 episodes of viral infections without any significant differences between stem cell sources. There were 8 cases (7 in BM, 1 in CB) of acute GVHD, 4 cases (2 in BM, 2 in CB) of graft failure and 3 cases of relapse (1 in BM, 2 in CB) after HSCT. The duration of median follow-up was 14.34+/-8.32 months in BM, 11.43+/-10.03 months in PB, and 16.56+/-13.76 months in CB. The overall and event free survival rate were 81.5% and 63.0%, respectively. CONCLUSION: There were no significant differences in episodes of infection between the types of HSCT. Although there were HLA mismatched donors for CB, the incidence of acute GVHD was lower, and graft failure or relapse rate was higher than BM.
Bacteremia ; Blood Platelets ; Bone Marrow Transplantation ; Child* ; Cord Blood Stem Cell Transplantation ; Disease-Free Survival ; Follow-Up Studies ; Graft vs Host Disease ; Hematologic Diseases* ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Incidence ; Neutrophils ; Peripheral Blood Stem Cell Transplantation ; Recurrence ; Retrospective Studies ; Stem Cells* ; Survival Rate ; Tissue Donors ; Transplants