• IMMUNE NETWORK
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• 제3권2호
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• pp.83-88
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• 2003

The number of umbilical cord blood transplantation is increasing worldwide as it has expanded the ability of the transplantaion community to meet the growing needs of their patients. Clinical data over the last decade show promising results in transplantation using both related as well as unrelated cord bloods. Cord blood banks are essential for the clinical use for transplantation and are now established around the world with the major efforts to standardize banking in collection, processing and distribution of cord blood for providing the highest quality stem cells for the patients. In Korea, Medipost, Histostem and some regional cord blood banks were established some years ago and collected thousands of cord blood for public but it had some limitations and was not expanded as the cord blood transplantation was not covered by medical insurance. Recently with the change in the policy of medical insurance to cover the cord blood transplantation, several venture companies are showing great interests in cord blood banking and trying to establish private cord blood banks in Korea. This review article discusses the current status of cord blood transplantaion and also the clincial use of stem cells from cord blood.

• Clinical and Experimental Pediatrics
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• 제55권3호
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• pp.93-99
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• 2012

Purpose: This study compared outcomes in children with acute leukemia who underwent transplantations with umbilical cord blood (UCB), bone marrow, or peripheral blood stem cells from a human leukocyte antigen (HLA)-matched related donor (MRD) or an unrelated donor (URD). Methods: This retrospective study included consecutive acute leukemia patients who underwent their first allogeneic hematopoietic stem cell transplantation (HSCT) at Samsung Medical Center between 2005 and 2010. Patients received stem cells from MRD (n=33), URD (n=46), or UCB (n=41). Results: Neutrophil and platelet recovery were significantly longer after HSCT with UCB than with MRD or URD ($p$ <0.01 for both). In multivariate analysis using the MRD group as a reference, the URD group had a significantly higher risk of grade III to IV acute graft-versus-host disease (GVHD; relative risk [RR], 15.2; 95% confidence interval [CI], 1.2 to 186.2; $p$=0.03) and extensive chronic GVHD (RR, 6.9; 95% CI, 1.9 to 25.2; $p$ <0.01). For all 3 donor types, 5-year event-free survival (EFS) and overall survival were similar. Extensive chronic GVHD was associated with fewer relapses (RR, 0.1; 95% CI, 0.04 to 0.6; $p$ <0.01). Multivariate analysis showed that lower EFS was associated with advanced disease at transplantation (RR, 3.2; 95% CI, 1.3 to 7.8; $p$ <0.01) and total body irradiation (RR, 2.1; 95% CI, 1.0 to 4.3; $p$=0.04). Conclusion: Survival after UCB transplantation was similar to survival after MRD and URD transplantation. For patients lacking an HLA matched donor, the use of UCB is a suitable alternative.

• Clinical and Experimental Pediatrics
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• 제52권6호
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• pp.725-729
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• 2009

중추신경계의 침범을 동반한 Epstein-Barr 바이러스 관련 혈구포식 림프조직구증은 조혈모세포이식을 시행하지 않으면 예후가 좋지 않다. 또한, 고식적인 강도의 전처치시 이식관련 사망률이 높다. 따라서 저자들은 진행성 중추신경계 침범을 보인 Epstein-Barr 바이러스 관련 혈구포식 림프조직구증 2례에서 저강도 전처치와 rituximab 후 타인 조혈모세포이식을 시행하여 치료하였기에 이를 보고하고자 한다.

• 종양간호연구
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• 제12권2호
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• pp.132-138
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• 2012

Purpose: The purpose of this study was to identify the performance status and quality of life (QOL) of patients after hematopoietic stem cell transplantation (HSCT) according to period of survival. Methods: Participants consists of 83 HSCT patients who were being treated regularly at out-patient clinic in two general hospitals in D city. Data were collected using questionnaires that were modified by Functional Assessment of Cancer Therapy-Bone Marrow Transplabtation (FACT-BMT) scale and Eastern Cooperative Oncology Group (ECOG). Results: The unrelated HSCT group's survival period was significantly worse than related HSCT group and autologous HSCT group. Performance status of the group with more than 3 years survival was significantly higher than that of the group with less than a year survival. The mean score of total QOL of HSCT patients was 2.69 out of 4. Total QOL was not significantly different among period of survival less than 1 year, 1-3 years, and more than 3 years. But BMT QOL was shown that the group with more than 3 years survival was higher than the groups with less than a year survival. Conclusion: Performance status and BMT QOL of the group with less than 1 year survival was significantly lowered than the groups with more than 3 years survival.

• Clinical and Experimental Pediatrics
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• 제49권2호
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• pp.173-180
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• 2006

목 적 : CMV 감염은 여전히 조혈모세포 이식 후 가장 중요한 감염 중 하나로 이환율과 사망률의 주요 원인이다. 조혈모세포 이식 후 CMV 감염 발생에 대한 위험인자의 분석 및 CMV pp65 항원혈증에 입각한 선제치료의 효과와 질환의 경과를 평가하고자 본 연구를 시행하였다. 방 법 : 1998년 10월부터 2003년 12월까지 가톨릭대학교 성모병원 소아과에서 이식을 시행받은 환아를 대상으로 하였다. pp66항원을 이용한 항원혈증검사를 토대로 혈연간 이식 환아의 경우 CMV 항원 양성세포가 5개 이상 발견된 경우, 비혈연간 이식 환아의 경우는 CMV 항원 양성세포가 하나라도 발견된 경우 ganciclovir 선제치료를 시작하였다. 결 과 : CMV 항원혈증은 대상 환아 213명 중 88명(41.3%)에서 관찰되었고, 각각 비혈연간 골수이식(62.5%), 비혈연간 제대혈이식(36.8%), HLA-일치 혈연간 이식(25.3%)이었다. 이식유형에 따른 CMV 항원혈증 발생확률은 비혈연간 골수이식($62.5{\pm}5.4%$)이 비혈연간 제대혈이식($36.8{\pm}7.8%$) 또는 HLA-일치 혈연간 이식($25.3{\pm}4.5%$)보다 통계적으로 유의하게 높았다. 단변량 분석에 의하면 비혈연간 이식, 이식 시 환자 연령(5세 이상), 이식 전 환자의 CMV-IgG, 전처치로 전신방사선조사의 사용 및 2도 이상의 급성 이식편대 숙주병의 발생이 CMV 항원혈증 발생의 위험인자이었다. 다변량분석에 의하면 비혈연간 이식, 이식전 환자의 CMV-IgG 양성상태 및 2도 이상의 급성 이식편대 숙주병의 발생이 독립적인 위험인자이었다. 이식환자 213명 중 7례(3.3%)에서 CMV 질환이 발생하였다(고항원혈증에서 6례 발생). 결 론 : 소아 조혈모세포 이식에 있어서 CMV 감염의 위험인자는 이식 전 환자의 CMV 혈청학적 상태, 조혈모세포 공급원, 급성 이식편대 숙주병이었으며, CMV 항원혈증에 입각한 ganciclovir 선제치료는 CMV 질환의 발생을 예방하는데 효과적이었다.

• Clinical and Experimental Pediatrics
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• 제58권6호
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• pp.199-205
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• 2015

Severe aplastic anemia (SAA) is a life-threatening disorder for which allogeneic hematopoietic stem cell transplantation (HSCT) is the current available curative treatment. HSCT from matched sibling donors (MSDs) is the preferred therapy for children with acquired SAA. For patients who lack MSDs, immunosuppressive therapy (IST) is widely accepted as a first-line treatment before considering HCT from an unrelated donor (URD). Given the recent progress in HSCT using URDs for childhood SAA, well-matched URDs became a realistic alternative for pediatric patients who have no suitable related donors and who are refractory to IST. However, it is quite challenging to treat patients with refractory SAA who lack suitable related or URDs. Even though haploidentical HSCT from genetically mismatched family members seemed to be an attractive procedure with the amazing benefit of readily available donors for most patients, early attempts were disappointing because of refractory graft-versus-host disease (GVHD) and excessively high transplant-related mortality. Recent advances with effective ex vivo depletion of T cells or unmanipulated in vivo regulation of T cells, better supportive care, and optimal conditioning regimens have significantly improved the outcome of haploidentical transplant. Besides considerable progress in the treatment of malignant diseases, recent emerging evidences for haploidentical HSCT in SAA has provided additional therapeutic options for patients with refractory diseases. Further improvements to decrease the rates of graft failure, GVHD, and infectious complications will facilitate the emergence of haploidentical HSCT as a front-line therapy for treating acquired SAA in children and adolescents who have no suitably matched donors.

• Clinical and Experimental Pediatrics
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• 제50권6호
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• pp.519-523
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• 2007

Aplastic anemia is a rare disease, which is characterized by pancytopenia and hypocellular bone marrow without infiltration of abnormal cells or fibrosis. The incidence in Asia is higher than in the West and new cases are diagnosed at a rate of 5.1 per million pediatric populations per year in Korea. The pathophysiology is understood roughly by defective hematopoiesis, impaired bone marrow micro-environment and immune mechanism. Treatments are performed on basis of pathogenesis and selected depending on the severity. Immunosuppressive therapy with antilymphocyte or antithymocyte globulin and cyclosporine is effective in the majority of patients but has some problems including relapse or clonal evolution. Recently, there have been clinical trials of immunosuppression with hematopoietic growth factors or other drugs. Allogeneic hematopoietic stem cell transplantation (HSCT) is curative in children with severe aplastic anemia. The overall survival in HSCT from HLA-identical sibling is higher than alternative donor, including HLA matched unrelated donor or cord blood. We have to consider quality of life after HSCT because of high survival rate. However, chronic graft versus host disease and graft failure are important factors that affect the quality of life and overall survival. We need further investigation to make new regimens aimed at overcoming these risk factors and perform clinical trials.

• Clinical and Experimental Pediatrics
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• 제55권3호
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• pp.100-106
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• 2012

Purpose: The survival rate for childhood acute lymphoblastic leukemia (ALL) has improved significantly. However, overall prognosis for the 20 to 25% of patients who relapse is poor, and allogeneic hematopoietic stem cell transplantation (HSCT) offers the best chance for cure. In this study, we identified significant prognostic variables by analyzing the outcomes of allogeneic HSCT in ALL patients in second complete remission (CR). Methods: Fifty-three ALL patients (42 men, 79%) who received HSCT in second CR from August 1991 to February 2009 were included (26 sibling donor HSCTs, 49%; 42 bone marrow transplantations, 79%). Study endpoints included cumulative incidence of acute and chronic graft-versus-host disease (GVHD), relapse, 1-year transplant-related mortality (TRM), disease-free survival (DFS), and overall survival (OS). Results: Cumulative incidences of acute GVHD (grade 2 or above) and chronic GVHD were 45.3% and 28.5%, respectively. The estimated 5-year DFS and OS for the cohort was $45.2{\pm}6.8%$ and $48.3{\pm}7%$, respectively. Only donor type, i.e., sibling versus unrelated, showed significant correlation with DFS in multivariate analysis ($p$=0.010). The rates of relapse and 1 year TRM were $28.9{\pm}6.4%$ and $26.4{\pm}6.1%$, respectively, and unrelated donor HSCT ($p$=0.002) and HLA mismatch ($p$=0.022) were significantly correlated with increased TRM in univariate analysis. Conclusion: In this single institution study spanning more than 17 years, sibling donor HSCT was the only factor predicting a favorable result in multivariate analysis, possibly due to increased TRM resulting from unrelated donor HSCT.

• Clinical and Experimental Pediatrics
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• 제45권7호
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• pp.912-916
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• 2002

제대혈 조혈모세포 이식은 악성 종양 및 혈액 질환의 치료에 있어 중요한 치료법인 조혈모세포 이식의 하나로 이식 편대 숙주병의 발생이 적어 비혈연간 환아에서의 제대혈 이식이 활발히 이루어지고 있다. 이에 저자들은 급성 골수구성 백혈병인 환아에서 성공적으로 호중구 및 혈소판 생착을 보인 비혈연간, 주조직 적합 항원-3개 불일치 제대혈 조혈모세포 이식을 경험하였기에 이에 보고하는 바이다.

• Clinical and Experimental Pediatrics
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• 제45권3호
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• pp.370-375
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• 2002

목 적 : 소아의 골수이형성 증후군은 드문 질환군으로 예후가 매우 불량하며 화학요법으로는 완치가 어렵다. 유일한 완치요법으로서 조혈모세포이식이 시행되고 있으나 소아의 경우 증례가 적어 이에 대한 체계적 결과 분석이 빈약한 실정이다. 저자들은 골수이형성증후군에서 조혈모세포이식을 시행한 증례들의 단기간의 결과와 이식합병증들을 분석하고자 하였다. 방 법 : 1995년 11월부터 2001년 1월까지 가톨릭대학교 성모병원 소아과에서 골수이형성 증후군으로 조혈모세포이식을 시행 받은 10명의 환아를 대상으로 하였다. 대상질환은 CMMoL 5례, RAEB 3례, RAEBt 2례이었고, 이식형태는 HLA-일치 형제간 골수이식 4례, 비혈연간 골수이식이 4례, 제대혈 조혈모세포이식이 1례, 가족간 HLA-부분일치 조혈모세포이식이 1례이었다. 전처치로는 BuCy 5례, TBI＋BuCy 2례, BuCy＋ATG, TBI＋Cy 및 TBI＋Melphalan이 각각 1례에서 사용되었다. 결 과 : 1) 10명 모두 생착(100%)되었으며 현재 8명(80%)이 무병생존(3-65개월, 정중 추적기간 11개월) 중이다. 2) 이식전처치로 인한 합병증으로 VOD가 3례에서 관찰되었으나 사망한 예는 없었다. 3) II-III도의 급성 이식편대 숙주병은 5례(50%)에서 발생하였으며 II가 4례, III가 1례이었다. 급성 이식 편대 숙주병과 관련된 사망은 없었다. 4) 전체 환아 10례 중 3례에서 이식 후 재발되었으나 1례는 화학요법 후 조혈모세포구제술에 의하여 현재 무병생존 중이며 2례는 사망하였다. 결 론: 소아 골수이형성 증후군에서 조혈모세포이식은 질환을 완치시킬 수 있는 우수한 결과를 보여주고 있으나 아직 증례가 적고 추적기간이 짧아 향후 더 많은 연구가 필요하다.