Blood Malignancies and Treatment

Biography

Biography: Young-Ho Lee

Abstract

Treatment of high-risk acute leukemia by allogeneic hematopoietic stem cell transplantation (HSCT) is an accepted therapeutic strategy. In recent years, cord blood (CB) has emerged as a feasible alternative source of hematopoietic progenitors for allogeneic HSCT who lack HLA-matched donors. Registry-based studies have established CB transplantation (CBT) as a safe and feasible alternative to BM transplantation (BMT) from unrelated donors when a matched sibling donor is not available. In a lot of studies, among patient-, disease- and transplant-related factors influencing outcome, a high cell dose in the graft, early disease status at transplantation and no more than 2 HLA-disparities in the donor-recipient pair (considering low-resolution typing of HLA-A and -B loci and high-resolution typing of HLA-DRB1 locus) have been associated with better outcomes. Several reports comparing the outcome of CBT and BMT from unrelated donor in children with acute leukemia did not show significant difference in leukemia-free survival (LFS) and overall survival (OS) in patients between the two groups. However, the delayed engraftment or graft failure and late immune reconstitution which could increase treatment related mortality (TRM) were the important factors to overcome. Therefore, the efforts for expanding the number of banked CB with high cell doses and tailored supportive cares to decrease TRM could improve the outcomes of CBT. Here, I would present a brief review of clinical data of CBT for acute leukemia in children and an impact of cytomegalovirus (CMV) infections in CBT recipients in regions of high CMV prevalence such as Korea. I would also introduce the national efforts to expand the qualified CBs with high cell doses and to improve outcome of CBT.