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Retroviral Gene Transfer in Autologous Bone Marrow and Stem Cell Transplantation
Published in Eric Wickstrom, Clinical Trials of Genetic Therapy with Antisense DNA and DNA Vectors, 2020
Rafat Abonour, Kenneth Cornetta
Peripheral blood progenitor cells (also referred to as peripheral blood stem cells) are obtained through the process of pheresis, in which leukocytes are selectively removed from the bloodstream and the patient's red cells, platelets and plasma are returned to the circulation. This outpatient procedure lasts approximately 4 hours and can be repeated daily. Two to three phereses are usually required to obtain sufficient cells for transplantation. In autologous transplantation, peripheral blood progenitor cells have replaced autologous marrow as the source of transplantable cells in most centers. We and others have also been evaluating the use of mobilized peripheral blood progenitors in the setting of allogeneic transplantation.
Oncology
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Radiation implant treatment—placing a small amount of radioactive material either directly into a cancer cell or in the affected area of the body—allows for use of higher doses. It also has the benefit of sparing most of the surrounding healthy tissue. Bone marrow transplantation (BMT) is another treatment approach that allows for delivery of higher doses of chemotherapy and/or radiation. The two primary types are allogenic (bone marrow from donor) and autologous (patient's own bone marrow). Peripheral blood stem cells (PBSCs) are also used in this procedure.
Hematopoietic Stem Cell Transplantation for Systemic Lupus Erythematosus
Published in Richard K. Burt, Alberto M. Marmont, Stem Cell Therapy for Autoimmune Disease, 2019
Ann E. Traynor, Richard K. Burt, Alberto Marmont
In the great majority of cases, mobilized peripheral blood stem cells (rather than bone marrow) were utilized. It is common knowledge that HSC may be harvested from the bone marrow or mobilized into the peripheral blood using either a hematopoietic colony stimulating factor such as G-CSF, a chemo therapeutic drug such as cyclophosphamide, or both. Since G-CSF is a pro-inflammatory cytokine which by itself may exacerbate disease, the stem cells are generally mobilized into the peripheral blood using cyclophosphamide in dosages varying from 2 to 4 g/ m2 and G-CSF usually beginning 72 hours after cyclophosphamide, with harvest by apheresis started upon white blood cell rebound, usually 10 days following cyclophosphamide. It should be emphasized that SLE patients, due to disease as well as chronic high dose corticosteroid therapy, are prone to infections and prophylactic antibiotics and/or inpatient mobilization may be prudent. These cells may then be positive selected, using an antibody to CD34, a progenitor cell antigen, resulting in a 4 log depletion of lymphocytes. The product, either unmanipulated or CD34 selected, is cryopreserved, thawed, and reinfused after the conditioning regimen has been given. It has been suggested that some lupus patients may be poor mobilizers, independently from having undergone previous cytotoxic treatments such as cyclophosphamide.6
Intensified conditioning regimen with fludarabine combined with post-transplantation cyclophosphamide for haploidentical allogeneic hematopoietic stem cell transplantation in children with high-risk acute leukemia
Published in Hematology, 2023
Junjie Cao, Xiaodong Xu, Ying Lu, Tiantian Wang, Dong Chen, Shuangyue Li, Xuhui Liu, Peipei Ye, Zhong-zheng Zheng, Renzhi Pei
A total of 22 patients with HR AL treated at The Affiliated People’s Hospital of Ningbo University from January 2015 to December 2021 were admitted into this study. They had PTCy intensified conditioning regimen (PTCy intensified group). We used an institutional database to retrospectively identify 18 children with HR AL who received modified Bu-Cy combined with ATG (ATG group) in the same period. All patients received a combination of bone marrow and peripheral blood stem cells. The eligibility criteria were HR AL patient younger than 18 years old and received PTCy intensified conditioning regimen. HR AL was defined according to previous definitions [10,11]. HR AL included induction treatment failure, adverse cytogenetic, minimal residual disease (MRD) persistent positive during chemotherapy, relapse more than twice, hyperleukocyte at diagnosis, as well as myelodysplastic syndrome (MDS) to acute myeloid leukemia (AML). Patients with severe infection and major organ dysfunction were excluded. All patients were fully informed of their disease status and treatment options. The informed consent was obtained from all patients and donors in accordance with the Declaration of Helsinki and the transplant protocol was approved by the institutional review board of our center.
Risk factors for transplant-associated thrombotic microangiopathy (TA-TMA): a systematic review and meta-analysis
Published in Expert Review of Hematology, 2023
Mengting Guo, Jiaqian Qi, Qixiu Hou, Xueqian Li, Yue Han
We expected that using PBSC as a source of stem cells would be associated with an increased incidence of TA-TMA but found results contrary to our hypothesis. The mechanism of this phenomenon remains unclear. Young JH et al. [26] compared the cumulative incidence of bloodstream bacterial infections in bone marrow and peripheral blood stem cell transplants. They found that the latter were significantly lower than the former (35% and 32.8% versus 44.8% and 47.9%), which could be a potential factor influencing the occurrence of TA-TMA. Patients who received PBSC had significantly faster lymphocyte recovery than BM transplants, particularly CD4 recovery, and quicker thymic recovery [27]. In addition, PBSC transplantation does not require general anesthesia and has less impact on the donor. Although faster recipient recovery and higher donor acceptance have led to a trend toward the widespread use of peripheral blood stem cells in clinical practice [28], there is still much controversy regarding their safety and side effects. The safety of PBSC needs to be further established to provide a more reliable basis for clinical selection.
Synchronizing the use of allogeneic hematopoietic cell transplantation in checkpoint blockade therapy for Hodgkin lymphoma
Published in Expert Review of Hematology, 2021
Alberto Mussetti, Anna Bosch Vilaseca, Rocío Parody, Annalisa Paviglianiti, Eva Domingo-Domenech, Ana Maria Sureda
In the pre-alloHCT group receiving CBT, most studies included small cohorts. However, a more recent study conducted in a large cohort of 209 patients with cHL receiving anti-PD1 mAbs before alloHCT reported a 2-year ORR of 80% [49]. Haploidentical donor was used in 46% of patients, while either matched-unrelated or related donors were used in 27% and 23% of cases, respectively. The most common conditioning regimens were reduced-intensity or non-myeloablative in 58% and 34% of patients, respectively. Peripheral blood stem cells were the preferred graft source in 75% of transplants. Progression-free survival (PFS) and relapse rate at 2 years were 70% and less than 20%, respectively. GVHD rates were similar to those in earlier studies. All-grade and grade 2–4 acute GVHD (aGVHD) incidences at 6 months were 54% and 37%, respectively. Chronic GVHD (cGVHD) incidence at 2 years was 34%. A PD-1-to-alloHCT interval <80 days was the only factor associated with an increase in grade 3–4 aGVHD. Additionally, the results suggested a lower incidence of cGVHD in patients who received post-transplant cyclophosphamide (PTCy) as GVHD prophylaxis. Despite a decrease in cGVHD incidence, the use of PTCy was also associated with reduced relapse when a haploidentical donor was used (7% at 2 years).