Posted On : Aug 08 , 2024
Posted By : CureSureMedico
Overview of Hematopoietic Cell Transplantation
Hematopoietic cell transplantation, or more simply bone marrow transplant, is one of the critical cancer treatments for diseases like leukemia, lymphoma, myeloma, etc. In it, either autologous or allogeneic stem cells from a matched donor or umbilical cord blood are used. In this procedure, a conditioning regimen comprised of high doses of chemotherapy is applied along with total body irradiation, before infusion of a healthy marrow. This high dose of chemotherapy and total body radiation restore the immune system and blood counts, leading towards the development of remission.
The Process in Parent-Child Transplantation
In this process, the stem cells utilized are obtained from the patient. High levels of chemotherapy are used on the patient. The high-dose treatment will kill the cancer cells but will also get rid of the blood-producing cells that are left in your bone marrow. Healthy cells are harvested from the related donor, then used in the autologous stem cell transplant. The gathered stem cells will be injected back into your bloodstream, and then the bone marrow starts to generate new blood cells.
Stem Cell Harvest
In autologous transplantation, it is relatively usual for doctors to collect stem cells from the bloodstream. These cells are referred to as peripheral blood stem cells (PBSCs).
Harvesting is not much more difficult than giving blood and is much easier than taking cells out of a person's bone marrow. Donor: Bone-marrow and cord blood bank Supplies for immune cell transplantation; does not require an operation or general anesthesia.
A few days prior to the PBSC collection, you will be started on a medication called G-CSF (filgrastim, Granix®, Neupogen®, Zarxio®), which is given by injection. It increases the number of stem cells being made. This medication can give you flu-like symptoms for the first few days after the injection is given. You may also experience aching and pains as a side effect of this medication. Sometimes another medication is given at the time of blood collection to help the stem cells move from your bone marrow to your blood stream where they can be more easily collected. This medication is called plerixafor (MozobilTM).
At Memorial Sloan Kettering, stem cells are harvested by the blood donor room on an apheresis machine. The transplant unit is also responsible for bone marrow stem cells for marrow donation as well as treatment modalities. Blood is taken from a vein and cycled through this piece of equipment which filters out the stem cells, one to five days. The other parts are then returned to your body.
Most people do not have any side effects from a blood collection and can return to their normal activities. The stem cells are frozen (cryopreserved) until they are given back to you.
Preparing for a Transplant
After your stem cells have been collected and the date of the transplant is known, you will undergo a process called a preparative regimen. This is sometimes also called conditioning or cytotoxic treatment. This is the step wherein chemotherapy is used, with or without radiation, in order to kill the leukemic cells. In allogenic HSCT induction, cyclophosphamide and melphalan are used for a body that is about to receive new stem cells. Our doctors tailor your treatment based on your disease and to the particular therapy to which it's most likely to respond.
The preparative regimen can be given over many days. Transplant is performed one or two days after the patient receives their last dose of chemotherapy or radiation.
Transplantation and Recovery
The collected stem cells are usually infused back into the patient's circulation like a blood transfusion. Prior to allogenic transplantation of stem cells, total body irradiation may be administered to eliminate the malignant cells. Shortly afterwards, the grafted stem cells localize themselves in the marrow cavity of the skeleton. From there, they gradually begin to reduce the output of nascent blood cells. Post-transplant, patients should be vigilant about certain complications, including mucositis and immunodeficiency.
Between two and three weeks after the transplant, the doctors typically begin to detect newly produced blood cells in the patient's blood. White cell counts are important for the right signs of a relapsed tumor after the transplant process. The successful graft from a transplant eventually gives rise to the patient's red and white cells, along with the platelets.
After a transplant, medical care is intensive during the days immediately following the procedure. You will be given irradiated blood products, such as platelets and red blood cells. You will also be given antibiotics to protect against or treat bacterial, viral, and fungal infections. You are at the highest risk for such infections during the first three months following transplant. To be most effectively treated, myelogenous leukemia and acute myeloid leukemia typically require cells harvested from donor T cells. People who have had stem cell transplants may also have complications because of the chemotherapy and radiation given before the transplant. Such complications may require more treatments.
Most people stay in the hospital for two to three weeks after a transplant. During this time, you will need special protection from infections. Everybody entering the room wearing gloves and masks is mandatory and washing hands with antiseptic soap, some entering have to wear clean disposable gowns on top of clothing. No fresh fruit, plants, or cut flowers should enter the environment because they carry disease-causing mold and/or bacteria. Accreditation ensures quality of bone marrow registry and cord blood banks.
