Page 312 - Essential Haematology

298 / Chapter 23 Stem cell transplantation

Principles of s tem c ell
Table 23.1 Stem cell transplantation:

t ransplantation potential donors.
Stem cell transplantation (SCT) involves eliminat-
HLA - matching sibling
’
ing a patient s haemopoietic and immune system by
chemotherapy and/or radiotherapy and replacing it Unrelated HLA - matching } Allogeneic
with stem cells either from another individual or volunteer
with a previously harvested portion of the patient s Umbilical cord blood
’
own haemopoietic stem cells (Fig. 23.1 ). Th e
Identical twin Syngeneic
term encompasses bone marrow transplantation
(BMT), in which stem cells are collected from Self Autologous
bone marrow, peripheral blood stem cell (PBSC)
transplantation and umbilical cord stem cell HLA, human leucocyte antigen.
transplantation.
SCT may be syngeneic (from an identical twin),
allogeneic (from another person) or autologous Table 23.2 Stem cell transplantation:

(from the patient s own stem cells) (Table 23.1 ). indications.
’
The principal diseases for which SCT is per-

formed are listed in Table 23.2 . However, the exact Allogeneic (or
role of SCT in the management of each disease is syngeneic) Autologous
complex and depends on factors such as disease Acute lymphoblastic or Hodgkin lymphoma
severity and subtype, remission status, age and, for myeloid leukaemia. and non - Hodgkin
allogeneic transplantation, availability of a donor. Other malignant lymphoma, multiple
disorders of the myeloma, AML,
marrow (e.g. chronic primary amyloidosis
Collection of s tem c ells myeloid leukaemia,
myelodysplasia,
Stem cells can be collected from the peripheral
multiple myeloma,
blood, bone marrow or umbilical cord blood.
lymphoma, severe
aplastic anaemia
Peripheral b lood s tem c ell c ollection including Fanconi ’ s
anaemia)
PBSCs are taken using a cell - separator machine
Inherited disorders:
connected to the patient or donor via peripheral
thalassaemia major,
cannulae (Fig. 23.2 ). Blood is taken through one sickle cell anaemia,
cannula and pumped around the machine where immune defi ciencies,
mononuclear cells are collected by centrifugation inborn errors of
before the red cells are returned to the patient. Th is metabolism in the
continuous process may take a few hours before haemopoietic and
enough mononuclear cells are collected. mesenchymal system
Peripheral blood normally contains too few hae- (e.g. osteopetrosis)
mopoietic stem cells to allow collection of suffi cient Other acquired severe
marrow diseases (e.g.
numbers for transplantation. Chemotherapy and
paroxysmal nocturnal
growth factors can each increase the number by
haemoglobinuria, red
around 10 – 100 times. Chemotherapy is used in
cell aplasia,
patients undergoing autologous stem cell collection myelofi brosis)
but not in healthy donors. PBSCs are usually col-
lected during the recovery phase from a cycle of
AML, acute myeloid leukaemia.
2
chemotherapy (e.g. 1.5 g/m cyclophosphamide). In