In recent years, umbilical cord blood (UCB) has widely been used as an alternative hematopoietic stem cell (HSC) source to treat various hematologic disorders in adults. UCB has several advantages over other HSC sources, including rapid availability, and lower or comparable incidence of severe acute graft-versus-host disease even with HLA-mismatched units. However, a high incidence of engraftment failure and early non-relapse mortality preclude UCB from use as a primary HSC source. A unique aspect of UCB transplantation (UCBT) is that Asian countries, particularly Japan, are leading the world in the number of UCBT procedures. This review is intended to give an update of UCBT outcomes in adults and problems to be solved, particularly focusing on engraftment failure.

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近年，移植前治療として行われる大量抗癌剤や放射線を減量することによって，従来では不可能であった高齢者への移植が可能となっている。加えて，HLA不一致移植の普及に伴い移植件数は年々増加しており，GVHD制御の重要性はさらに高まっている。しかしHLA一致同胞間移植においても致死的GVHDの発生を完全にコントロールできておらず，また，ステロイド治療抵抗性GVHDへのアプローチは手探りの状態と言っても過言ではない。急性GVHDの病態に関する最近の知見として，獲得免疫に加え自然免疫のGVHD発症への関与，ドナーT細胞とホスト抗原提示細胞以外の免疫担当細胞の役割，血管を含む上皮系細胞の重要性が明らかとなりつつある。病態の解明が進むにつれ，多彩な作用機序をもつ薬剤や，制御性T細胞や間葉系幹細胞といった細胞療法が開発されている。

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Objective:The role of allogeneic hematopoietic stem cell transplantation (allo-SCT) for plasma cell myeloma (PCM) is still controversial. We investigated the effectiveness of reduced-intensity conditioning (RIC) allo-SCT in patients with PCM. Patients and Methods:We retrospectively studied a series of 10 PCM patients who underwent allo-SCT using reducedintensity conditioning (RIC) mainly consisting of fludarabine, busulfan, and low-dose total body irradiation from 2001 to 2006 in our single center. Of the 10 patients, 7 received allo-SCT from an HLA-matched related donor, 2 from an HLAmatched unrelated donor, and 1 from an HLA-2-mismatched unrelated donor. Results:All patients showed leukocyte and platelet engraftment. Seven patients developed grade II ― III acute graft-versushost disease (GVHD), and 4 developed extensive chronic GVHD. With a median follow-up of 90 months, the 5-year progression-free and overall survival rates were 34% and 69%, respectively. Six patients survived for more than 7 years after allo-SCT, and 3 of them are currently in continuous complete response (CR). Five of the 6 long-term survivors received allo-SCT from an HLA-matched related donor during the first remission within 10 months after the diagnosis.However, 4 patients who died of transplant-related toxicity or progressive disease received allo-SCT with relapsed disease more than 20 months after the diagnosis. Conclusion:These results suggested that RIC allo-SCT for PCM has the potential to result in a long-term CR if allo-SCT is performed during the remission of PCM in an early period after the diagnosis.

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症例は34歳，女性。IgA-λ型多発性骨髄腫に対して多剤併用化学療法，自家末梢血幹細胞移植を施行後，非血縁者間同種骨髄移植を施行した。移植後にcomplete responseが得られたが，移植後7 ヶ月目に再発した。Lenalidomide 25mg/dayの投与を開始。Lenalidomideを開始したところ，9日目に下痢・嘔吐が出現した。下部消化管内視鏡にて大腸粘膜の浮腫・びらんを認め，病理組織により腸管GVHDと診断された。Lenalidomideを中止すると共にステロイドの投与を開始し，速やかに症状の改善を認めた。同種造血幹細胞移植後のlenalidomide投与によりGVHDを発症した症例の報告は散見されるが，本邦からは報告されていない。同種造血幹細胞移植後にlenalidomideを投与する際にはGVHDの発症・再燃に十分に留意する必要がある。

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