Lecture 19 - HSC Transplantation

Lecture 19 - HSC Transplantation - Lecture 9 HSC...

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Lecture 9 – HSC Transplantation Blood and Marrow Hematopoietic Stem Cell Transplantation - - Allogeneic: The permanent transfer of hematopoietic stem cells from one individual to another - Autologous: The re-implantation of stem cells into a patient after their earlier removal. - **Success is measured as “ engraftment ” defined as the regeneration of all blood cell lineages (erythrocytes, leukocytes including lymphocytes, and platelets) from the donor stem cells. - The general trend 1980-2009 o Autologous done more commonly than allogeneic o Transplant indicated for MM> NHL>AML>HD>ALL>DMS/MPD>Aplastic Anemia>CML, other cancer/leukemia - What is hematopoietic stem cell o Resides in the bone marrow, and possibly other locations (0.01% of marrow cells) o Capable of self-renewal o Capable of asymmetric division one daughter cell capable of terminal differentiation into blood cells another daughter cell stays behind and remain undifferentiated o Characterized by expression of unique cell surface antigens such as CD34, CD133, and c-kit, as well as drug-resistance proteins (MDR), but not antigens expressed on differentiated cells o Can be “mobilized” from the marrow to the peripheral blood by cytokines (e.g. G-CSF) - *** IMPORTANT *** o KNOW that everything comes from pluripotent stem cell -- this is what your patient would need
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Allogeneic Autologous Indication - More common in AML, ALL , MDS, MPD, CML, Aplastic anemia Indications - Common in MM , NHL, HD - Acute leukemia - Lymphomas - NHL, Hodgkin’s - Solid tumors o (testicular, neuroblastoma, Ewings) - Autoimmune diseases o SLE o MS Goal : Eliminate recipient’s own marrow stem cells and achieve engraftment of transplanted stem cells, creating a state of “chimerism” [which means germ line is the pt’s, stem cells are from donors] Missing or defective stem cells aplastic anemia (AA) myelodysplastic syndrome (MDS) Replace defective immune system severe combined immunodeficiency Replace missing (or defective) proteins metabolic and storage diseases hemoglobinopathy (see a lot in thalassemias) Eliminate malignant cells Facilitate Graft-versus-Malignancy effect Goal : - Allow high doses of chemotherapy (and radiotherapy ) otherwise dose-limited by bone marrow sensitivity o Leukemia o Lymphoma o Multiple Myeloma o Solid tumors, germ cell tumors (i.e. testicular cancer) o Autoimmune diseases **patients with auto-allo are better than auto-auto survival rate increase! Source
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Lecture 19 - HSC Transplantation - Lecture 9 HSC...

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