Peripheral stem cell transplantation

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Peripheral stem cell transplantation
Hematopoietic stem cell.jpg
A bag of freshly transplanted peripheral blood stem cells
Specialty hematology

Peripheral blood stem cell transplantation (PBSCT), also called "Peripheral stem cell support", [1] is a method of replacing blood-forming stem cells. Stem cells can be destroyed through cancer treatments such as chemotherapy or radiation, as well as any blood-related diseases, such as leukemia, lymphoma, neuroblastoma and multiple myeloma. [2] PBSCT is now a much more common procedure than its bone marrow harvest equivalent due to the ease and less invasive nature of the procedure. [3] [4] Studies suggest that PBSCT has a better outcome in terms of the number of hematopoietic stem cell (CD34+ cells) yield. [5]

Contents

Immature hematopoietic stem cells in the circulating blood that are similar to those in the bone marrow are collected by apheresis from a donor (PBSC collection). The product is then administered intravenously to the patient after treatment. The administered hematopoietic stem cells then migrate to the recipient's bone marrow, through a process known as stem cell homing, where the transplanted cells override the previous bone marrow. This allows the bone marrow to recover, proliferate and continue producing healthy blood cells.[ citation needed ]

The transplantation may be autologous (an individual's own blood cells), allogeneic (blood cells donated by someone else with matching HLA), or syngeneic (blood cells donated by an identical twin). The apheresis procedure typically lasts for 4–6 hours, depending on the blood volume of the donor. [6]

Preparation prior to PBSC Collection

Granulocyte colony stimulating factor (GCSF) are naturally occurring glycoproteins that stimulate white blood cell proliferation. Filgrastim is a synthetic form of GCSF produced in E.coli . [7] PBSC donors are given a course of GCSF prior to PBSC collection. The increase in white blood cell proliferation as a result of the Filgrastim ensures a better results from the donation. The course is usually given over a 4-day period prior to PBSC collection. [8] The most common side effects of Filgrastim are bone, joint, back, arm, leg, mouth, throat, and muscle pain. [9] Additionally, headache, nausea, vomiting, dizziness, fatigue, rash, loss of appetite, and difficulty falling or staying asleep are common. [9]

Complications

Since allogeneic PBSCT involves transformation of blood between different individuals, this naturally carries more complications than autologous PBSCT. [10] For example, calculations must be made to ensure consistency in the amount of total blood volume between the donor and recipient. If the total blood volume of the donor is less than that of the recipient (such as when a child is donating to an adult), multiple PBSCT sessions may be required for adequate collection. Performing such a collection in a single setting could result in risks such as hypovolemia, which could lead to cardiac arrest and death. Health care providers must exercise careful precaution when considering donor-recipient matching in allogeneic PBSCT. [11]

History

An early example of a successful peripheral stem cell transplant was carried out in the wake of the 1999 Tokaimura nuclear accident. Hisashi Ouchi, who received the highest dose of radiation was treated with PBSCT in an attempt to restore his destroyed immune system. Cells from the patient's sister's bone marrow were administered, and in the following weeks successfully began dividing and differentiating into white blood cells. However, several weeks later, the cells were found to have been mutated by the radiation still present within the patient's body, and were observed carrying out autoimmune responses. [12] Later studies on the incident and subsequent use of PBSCT found that the transplant had also induced neoendothelialization of the aortic endothelium. [13]

Related Research Articles

<span class="mw-page-title-main">Bone marrow</span> Semi-solid tissue in the spongy portions of bones

Bone marrow is a semi-solid tissue found within the spongy portions of bones. In birds and mammals, bone marrow is the primary site of new blood cell production. It is composed of hematopoietic cells, marrow adipose tissue, and supportive stromal cells. In adult humans, bone marrow is primarily located in the ribs, vertebrae, sternum, and bones of the pelvis. Bone marrow comprises approximately 5% of total body mass in healthy adult humans, such that a man weighing 73 kg (161 lbs) will have around 3.7 kg (8 lbs) of bone marrow.

<span class="mw-page-title-main">Granulocyte colony-stimulating factor</span> Mammalian protein found in Homo sapiens

Granulocyte colony-stimulating factor, also known as colony-stimulating factor 3, is a glycoprotein that stimulates the bone marrow to produce granulocytes and stem cells and release them into the bloodstream.

<span class="mw-page-title-main">Hematopoietic stem cell transplantation</span> Medical procedure to replace blood or immune stem cells

Hematopoietic stem-cell transplantation (HSCT) is the transplantation of multipotent hematopoietic stem cells, usually derived from bone marrow, peripheral blood, or umbilical cord blood in order to replicate inside of a patient and to produce additional normal blood cells. It may be autologous, allogeneic or syngeneic.

<span class="mw-page-title-main">Graft-versus-host disease</span> Medical condition

Graft-versus-host disease (GvHD) is a syndrome, characterized by inflammation in different organs. GvHD is commonly associated with bone marrow transplants and stem cell transplants.

A cord blood bank is a facility which stores umbilical cord blood for future use. Both private and public cord blood banks have developed in response to the potential for cord blood in treating diseases of the blood and immune systems. Public cord blood banks accept donations to be used for anyone in need, and as such function like public blood banks. Traditionally, public cord blood banking has been more widely accepted by the medical community. Private cord blood banks store cord blood solely for potential use by the donor or donor's family. Private banks typically charge around $2,000 for the collection and around $200 a year for storage.

<span class="mw-page-title-main">Hematopoietic stem cell</span> Stem cells that give rise to other blood cells

Hematopoietic stem cells (HSCs) are the stem cells that give rise to other blood cells. This process is called haematopoiesis. In vertebrates, the very first definitive HSCs arise from the ventral endothelial wall of the embryonic aorta within the (midgestational) aorta-gonad-mesonephros region, through a process known as endothelial-to-hematopoietic transition. In adults, haematopoiesis occurs in the red bone marrow, in the core of most bones. The red bone marrow is derived from the layer of the embryo called the mesoderm.

<span class="mw-page-title-main">Cell therapy</span> Therapy in which cellular material is injected into a patient

Cell therapy is a therapy in which viable cells are injected, grafted or implanted into a patient in order to effectuate a medicinal effect, for example, by transplanting T-cells capable of fighting cancer cells via cell-mediated immunity in the course of immunotherapy, or grafting stem cells to regenerate diseased tissues.

Total body irradiation (TBI) is a form of radiotherapy used primarily as part of the preparative regimen for haematopoietic stem cell transplantation. As the name implies, TBI involves irradiation of the entire body, though in modern practice the lungs are often partially shielded to lower the risk of radiation-induced lung injury. Total body irradiation in the setting of bone marrow transplantation serves to destroy or suppress the recipient's immune system, preventing immunologic rejection of transplanted donor bone marrow or blood stem cells. Additionally, high doses of total body irradiation can eradicate residual cancer cells in the transplant recipient, increasing the likelihood that the transplant will be successful.

The National Marrow Donor Program (NMDP) is a nonprofit organization founded in 1986 and based in Minneapolis, Minnesota, that operates the Be The Match Registry of volunteer hematopoietic cell donors and umbilical cord blood units in the United States.

<span class="mw-page-title-main">Plerixafor</span> Chemical compound

Plerixafor, sold under the brand name Mozobil, is an immunostimulant used to mobilize hematopoietic stem cells in cancer patients into the bloodstream. The stem cells are then extracted from the blood and transplanted back to the patient. The drug was developed by AnorMED, which was subsequently bought by Genzyme.

Donor lymphocyte infusion (DLI) or buffy coat infusion is a form of adoptive immunotherapy used after hematopoietic stem cell transplantation.

Autologous stem-cell transplantation is autologous transplantation of stem cells—that is, transplantation in which stem cells are removed from a person, stored, and later given back to that same person.

Transplantable organs and tissues may refer to both organs and tissues that are relatively often transplanted, as well as organs and tissues which are relatively seldom transplanted. In addition to this it may also refer to possible-transplants which are still in the experimental stage.

<span class="mw-page-title-main">Gift of Life Marrow Registry</span> Public bone marrow and blood stem cell registry

The Gift of Life Marrow Registry is a public bone marrow and blood stem cell registry headquartered in Boca Raton, Florida. Gift of Life facilitates transplants for children and adults suffering from life-threatening illnesses, including leukemia, lymphoma, other cancers and genetic diseases.

Graft-versus-tumor effect (GvT) appears after allogeneic hematopoietic stem cell transplantation (HSCT). The graft contains donor T cells that can be beneficial for the recipient by eliminating residual malignant cells. GvT might develop after recognizing tumor-specific or recipient-specific alloantigens. It could lead to remission or immune control of hematologic malignancies. This effect applies in myeloma and lymphoid leukemias, lymphoma, multiple myeloma and possibly breast cancer. It is closely linked with graft-versus-host disease (GvHD), as the underlying principle of alloimmunity is the same. CD4+CD25+ regulatory T cells (Treg) can be used to suppress GvHD without loss of beneficial GvT effect. The biology of GvT response still isn't fully understood but it is probable that the reaction with polymorphic minor histocompatibility antigens expressed either specifically on hematopoietic cells or more widely on a number of tissue cells or tumor-associated antigens is involved. This response is mediated largely by cytotoxic T lymphocytes (CTL) but it can be employed by natural killers as separate effectors, particularly in T-cell-depleted HLA-haploidentical HSCT.

<span class="mw-page-title-main">Haematopoietic system</span>

The haematopoietic system is the system in the body involved in the creation of the cells of blood.

Microtransplantation (MST) is an advanced technology to treat malignant hematological diseases and tumors by infusing patients with granulocyte colony-stimulating factor (G-CSF) mobilized human leukocyte antigen (HLA)-mismatched allogeneic peripheral blood stem cells following a reduced-intensity chemotherapy or targeted therapy. The term "microtransplantation" comes from its mechanism of reaching donor cell microchimerism.

Guo Mei is a hematologist and associate director of 307th Hospital of Chinese People’s Liberation Army and deputy director of Radiation Research Institute.

<span class="mw-page-title-main">Shimon Slavin</span> Israeli professor of medicine

Shimon Slavin, M.D., is an Israeli professor of medicine. Slavin pioneered the use of immunotherapy mediated by allogeneic donor lymphocytes and innovative methods for stem cell transplantation for the cure of hematological malignancies and solid tumors, and using hematopoietic stem cells for induction of transplantation tolerance to bone marrow and donor allografts.

<span class="mw-page-title-main">Martin Körbling</span> German professor of medicine

Martin Körbling is a German-American internist and hematologist, university professor, medical researcher and pioneer of blood stem cell transplantation.

References

  1. ↑ "Dictionary of Cancer Terms". 2011-02-02. Retrieved 2 March 2012.
  2. ↑ "Frequently asked questions about stem cell research". Mayo Clinic. Retrieved 2021-04-15.
  3. ↑ "Stem Cell Transplant (Peripheral Blood, Bone Marrow, and Cord Blood Transplants)" . Retrieved 4 March 2012.
  4. ↑ "Peripheral Blood Stem Cell Harvest" . Retrieved 4 March 2012.
  5. ↑ Singhal, S; Powles, R; Kulkarni, S; Treleaven, J; Sirohi, B; Millar, B; Shepherd, V; Saso, R; Rowland, A; Long, S; Cabral, S; Horton, C; Mehta, J (March 2000). "Comparison of marrow and blood cell yields from the same donors in a double-blind, randomized study of allogeneic marrow vs blood stem cell transplantation". Bone Marrow Transplantation. 25 (5): 501–5. doi: 10.1038/sj.bmt.1702173 . PMID   10713626.
  6. ↑ "Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation". 2005-09-09.
  7. ↑ Welte, K; Gabrilove, J; Bronchud, MH; Platzer, E; Morstyn, G (Sep 15, 1996). "Filgrastim (r-metHuG-CSF): the first 10 years". Blood. 88 (6): 1907–29. doi: 10.1182/blood.V88.6.1907.bloodjournal8861907 . PMID   8822908.
  8. ↑ "G-CSF Administration".
  9. 1 2 "Filgrastim Injection: MedlinePlus Drug Information". medlineplus.gov. Retrieved 2021-04-15.
  10. ↑ Cutler, C; Antin, JH (2001). "Peripheral blood stem cells for allogeneic transplantation: a review". Stem Cells. 19 (2): 108–17. doi: 10.1634/stemcells.19-2-108 . PMID   11239165.
  11. ↑ Sevilla, J; Plaza, SF; González-Vicent, M; Lassaletta, A; Ramírez, M; Madero, L; Díaz, MA (2007). "PBSC collection in extremely low weight infants: a single-center experience". Cytotherapy. 9 (4): 356–61. doi:10.1080/14653240701320270. PMID   17573611.
  12. ↑ Nagayama, Hitomi; Ooi, Jun; Tomonari, Akira; Iseki, Tohru; Arinobu, Tojo; Tani, Kenzaburo; Takahashi, Tsuneo A.; Yamashita, Naohide; Asano, Shigetaka (2002). "Severe Immune Dysfunction after Lethal Neutron Irradiation in a JCO Nuclear Facility Accident Victim". International Journal of Hematology . 76 (2): 157–164. doi:10.1007/BF02982579. PMID   12215015. S2CID   9152173.
  13. ↑ Suzuki, T.; Nishida, M.; Futami, S.; Fukino, K.; Amaki, T.; Aizawa, K.; Chiba, S.; Hirai, H.; Maekawa, K.; Nagai, R. (2003). "Neoendothelialization after peripheral blood stem cell transplantation in humans: a case report of a Tokaimura nuclear accident victim". Cardiovascular Research. NCBI. 58 (2): 487–92. doi: 10.1016/s0008-6363(02)00780-0 . PMID   12757883.

PD-icon.svg This article incorporates public domain material from Dictionary of Cancer Terms. U.S. National Cancer Institute.

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