Hematopoietic Stem Cell Transplantation

Hematopoietic stem cell transplantation is the accepted therapy of choice for a variety of malignant and non-malignant diseases in children and adults. Initially developed as rescue therapy for a patient with cancer after high doses of chemotherapy and radiation as well as the correction of severe defi ciencies in the hematopoietic system, it has evolved into an adoptive immune therapy for malignancies and autoimmune disorders. The procedure has helped to obtain key information about the bone marrow environment, the biology of hematopoietic stem cells and histocompatibility. The development of this new discipline has allowed numerous groups working around the world to cure patients of diseases previously considered lethal. Together with the ever growing list of volunteer donors and umbilical cord blood banks, this has resulted in life saving therapy for thousands of patients yearly. We present an overview of the procedure from its cradle to the most novel applications, as well as the results of the HSC transplant program developed at our institution since 1989.

Frontiers in immunology, 2016

Since the early beginnings, in the 1950s, hematopoietic stem cell transplantation (HSCT) has become an established curative treatment for an increasing number of patients with life-threatening hematological, oncological, hereditary, and immunological diseases. This has become possible due to worldwide efforts of preclinical and clinical research focusing on issues of transplant immunology, reduction of transplant-associated morbidity, and mortality and efficient malignant disease eradication. The latter has been accomplished by potent graft-versus-leukemia (GvL) effector cells contained in the stem cell graft. Exciting insights into the genetics of the human leukocyte antigen (HLA) system allowed improved donor selection, including HLA-identical related and unrelated donors. Besides bone marrow, other stem cell sources like granulocyte-colony stimulating-mobilized peripheral blood stem cells and cord blood stem cells have been established in clinical routine. Use of reduced-intensit...

Dr. Nithish Sattoju, Dr. Anvesh Maram, Dr. Prashanth Tholkatta , Dr. Vijaykanth Lavudi , Dr. E. Jagadish Kumar

Formation or development of a new cell or an entire human being requires an actively diving cell, which we refer as Stem Cell. By discovering the potency of a stem cell in forming new cells, tissues & organs, the thought of application or use of stem cells in treating various irreversible tissue/ organ damages came out. Different stem cells are responsible in producing different tissues/ organs. With the advent that the stem cells do exist in the adults & can be extracted specifically, various stem cell transplantations took over in treating lethal diseases like cancer, diabetes, etc. The process of stem cell therapy & its applications in various fields of medical sciences is lot to be known. The current study provides a detailed glance on various aspects of one of the majorly studied/ known stem cell transplantations, Haematopoietic Stem Cell Transplantation. Key Words: Haematopoietic stem cell transplantation; Stem Cells; Irreversible tissue/ organ damage; Autologous S.C.T.; Allogenic S.C.T.; Bone Marrow Transplantation; Peripheral Blood Stem Cell Transplantation; Immuno-phenotyping; Stem Cell Mobilisation.

Advances in Hematopoietic Stem Cell Research, 2012

Bone Marrow Transplantation, 2009

Journal of Autoimmunity, 2009

HLA, 2017

Immunologic Research, 2003

Originally, allogeneic hematopoietic stem cell transplantation (HSCT) was viewed as a form of rescue from the marrow lethal effects of high doses of chemo-radiotherapy used to both eradicate malignancy and to provide sufficient immunosuppression to ensure allogeneic engraftment. Clear evience of a therapeutic graft-versustumor (GVT) effect mediated by allogeneic effector cells (T cells) has prompted the exploration of HSCT regimens that rely solely upon host immunosuppression (non-myeloablative) to facilitate allogeneic donor engraftment. The engrafted donor effector cells are then used to accomplish the task of eradicating host malignant cells. The non-myeloblative regimen developed in Seattle uses 2 Gy total body irradiation (TBI) before transplant followed by postgrafting cyclosporine (CSP) and mycophenolate mofetil (MMF). This regimen resulted in initial mixed donor-host chimerism in all patients with hematologic malignancies and genetic disorders who received HLA-matched sibling allografts. The 17% incidence of graft rejection was reduced to 3% with the addition of fludarabine, 30 mg/m 2 /day on d -4, -3, and -2. The non-myeloablative combination of fludarabine/TBI has also been successful at achieving high engraftment rates in recipients of 10 of 10 HLA antigen matched unrelated donor HSCTs in patients with hematologic malignancies. By reducing acute toxicities relative to conventional HSCT, most patients have received their pre-and post-HSCT therapy almost exclusively as outpatients. Acute and chronic GVHD occur after non-myeloablative HSCT, but the incidence and severity appear less compared to conventional HSCT. As in conventional transplants, immune dysregulation from GVHD and its treatment and delayed reconstitution of immune function continue to present risks to patients who have otherwise undergone successful non-myeloablative HSCT. Cellular therapeutic effects have been observed after non-myeloablative HSCT such as correction of inherited genetic disorders, and eradication of hematologic malignant diseases and renal cell carcinoma via GVT responses.

The Medical journal of Malaysia, 2009

Haematopoietic stem cell transplantation (HSCT) has progressed rapidly since its introduction about five decades ago. There is now an increasing demand for transplant physicians in both public and private domains to perform this procedure in view of significant improvement of remission rates in haematological malignancies and increasing indications of HSCT. Peripheral blood has largely replaced bone marrow as the preferred source of haematopoietic stem cells (HSC). Transplantation-related mortality and morbidity rates have considerably decreased because of improved conditioning regimens, human leukocyte antigen (HLA) typing methods, supportive care, and most importantly, prophylaxis, diagnosis and treatment of serious infections. New transplantation strategies, such as reduced intensity transplantation, have extended the use of allogeneic transplant to patients with older age and co-morbidities. Current efforts are focused on ways to increase the donor pool and to improve the long t...

Prilozi / Makedonska akademija na naukite i umetnostite, Oddelenie za biološki i medicinski nauki = Contributions / Macedonian Academy of Sciences and Arts, Section of Biological and Medical Sciences

Stem cell research still remains one of the most controversial fields of science today on account cell plasticity and its capability of transdifferentiation or de-differentiations to certain tissue types, as well as the clinical application of this scientific concept. Stem cells derived from bone marrow, peripheral blood or the umbilical cords are a common therapeutic approach for treatment of haematological malignancies as part of established transplant procedures (allogeneic, autologous, syngeneic stem cell transplantation). But recent clinical data have revealed the potential role of stem cells in the treatment of other nonhaematological diseases, degenerative disorders, cardiovascular diseases and autoimmune diseases. The experience with stem cell transplantation in haematological malignancies at the Hematology Department, Skopje, has been established since it was set up 7 years ago, with more than 130 patients undergoing transplant procedures (87 autologous and 43 allogeneic re...