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🌱 來自: hematopoietic stem cell transplantation

transplantation procedure (for Allo HSCT)

Pre-Tx conditioning regimen goal:

immunosuppression to allow donor cell engraftment & anti-tumor efficacy to ↓ relapse risk. Type and dose of agents determine this balance.

Myeloablative conditioning:

high-dose chemo and/or total body irradiation.

• Low relapse rates,
• high immunosuppression,
• higher transplant-related morbidity.

Reduced-intensity conditioning (“RIC”):

• lower dose of chemo →
  • ↓ transplant-related morbidity/mortality,
  • but ↑ relapse b/c it relies more on GVT effect
  • (Blood 2015;126:23).
• Allows allo HSCT
  • for older adults (>60) or
  • Pts w/ comorbidities.

Sources of hematopoietic stem cells (NEJM 2012;367:1487)

Bone marrow (BM):

• original source
• preferred in non-malignant disease,
• ↓ GVHD rates

Peripheral blood stem cells (PBSC):

• easier to collect
• more commonly used
• BM vs. PBSC ≈ survival
• BM ↓ chronic GVHD, PBSC ↓ graft failure
• faster engraftment

Umbilical cord blood stem cells (UCB): see above in Types of Allo HSCT

Engraftment:

• (ANC) recovers to 500/µL w/in
  • 2 wk w/ PBSC
  • 2.5 wk w/ BM
  • 4 wk w/ UCB
• G-CSF accelerates recovery by 3–5 d in all scenarios.