Transplantation of Haematopoietic Stem Cells


Haematopoietic cell transplantation encompasses infusion of progenitor cells (stem cells) into patients with haematological and other diseases. These cells can be obtained from the patients themselves (autologous) or from somebody else (allogeneic). The source of the cells can be bone marrow or peripheral or cord blood. Autologous transplantation can be used as consolidation for diseases like lymphoma and myeloma. Allogeneic transplantation can be potentially curable in certain diseases like bone marrow failure syndromes, leukaemias and myelodysplastic syndrome. There are several types of donors available including sibling, unrelated (adult or cord blood) and haploidentical. Chemotherapy ± radiation is given before infusion of these cells. In addition, there are risks of acute and chronic graft‐versus‐host disease as well as infections. Ongoing studies seek to improve the outcomes of these transplantations.

Key Concepts:

  • Haematopoietic cell transplantation is a process which includes treatment of a patient with chemotherapy ± radiation after which the patient receives infusion of stem cells.

  • Autologous transplantation implies receiving patients' own stem cells.

  • Allogeneic transplantation implies receiving stem cells from another person (donor).

  • Donor options include sibling, related or unrelated adult and umbilical cord blood.

  • Haematopoietic cell transplantation can be performed for malignant and nonmalignant haematological disease.

  • Stem cells can be obtained from peripheral blood after mobilisation or from bone marrow.

  • Acute and chronic graft‐versus‐host disease are common complications, which are the process of graft recognising patient (recipient) as foreign and hence initiating an immune response against them.

  • Acute and chronic graft‐versus‐host disease are treated with immune‐suppressive agents, which can cause problems with infections.

  • Long‐term survivors should be monitored closely for long‐term complications.

Keywords: stem cells; transplantation; haematopoietic; malignancy; graft

Figure 1.

Causes of death after autologous and allogeneic transplants using matched sibling or unrelated donors.

Reproduced by permission from CIBMTR (Centre for International Blood and Marrow Transplant Research). © CIBMTR.
Figure 2.

Trends in transplants by HCT type and recipient age.

Reproduced by permission from CIBMTR. © CIBMTR.
Figure 3.

Indications for HCT by disease type for autologous and allogeneic HCT.

Reproduced by permission from CIBMTR. © CIBMTR.
Figure 4.

Stem cell sources for HCT showing trends from 2000 to 2009 for patients younger and older than 20 years.

Reproduced by permission from CIBMTR. © CIBMTR.


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Further Reading

Bacigalupo A , Ballen K , Rizzo D et al. (2009) Defining the intensity of conditioning regimens: working definitions. Biology of Blood and Marrow Transplantation 15(12): 1628–1633.

Bhatia S , Francisco L , Carter A et al. (2007) Late mortality after allogeneic hematopoietic cell transplantation and functional status of long‐term survivors: report from the Bone Marrow Transplant Survivor Study. Blood 110(10): 3784–3792.

Gisselbrecht C , Glass B , Mounier N et al. (2010) Salvage regimens with autologous transplantation for relapsed large B‐cell lymphoma in the rituximab era. Journal of Clinical Oncology 28(27): 4184–4190.

Goldstone AH , Richards SM , Lazarus HM et al. (2008) In adults with standard‐risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients: final results of the International ALL Trial (MRC UKALL XII/ECOG E2993). Blood 111(4): 1827–1833.

Gupta V , Tallman MS , He W et al. (2010) Comparable survival after HLA‐well‐matched unrelated or matched sibling donor transplantation for acute myeloid leukemia in first remission with unfavorable cytogenetics at diagnosis. Blood 116(11): 1839–1848.

Koreth J , Schlenk R , Kopecky KJ et al. (2009) Allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission: systematic review and meta‐analysis of prospective clinical trials. Journal of the American Medical Association 301(22): 2349–2361.

Martin PJ , Counts GW Jr , Appelbaum FR et al. (2010) Life expectancy in patients surviving more than 5 years after hematopoietic cell transplantation. Journal of Clinical Oncology 28(6): 1011–1016.

Moreno C , Villamor N , Colomer D et al. (2005) Allogeneic stem‐cell transplantation may overcome the adverse prognosis of unmutated VH gene in patients with chronic lymphocytic leukemia. Journal of Clinical Oncology 23(15): 3433–3438.

Weisdorf DJ , Anasetti C , Antin JH et al. (2002) Allogeneic bone marrow transplantation for chronic myelogenous leukemia: comparative analysis of unrelated versus matched sibling donor transplantation. Blood 99(6): 1971–1977.

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Alam, Naheed, and Kim, Dennis(Sep 2013) Transplantation of Haematopoietic Stem Cells. In: eLS. John Wiley & Sons Ltd, Chichester. [doi: 10.1002/9780470015902.a0001247.pub3]