Hematopoietic Stem Cell Transplantation (HSCT)

What is Hematopoietic Stem Cell Transplantation (HSCT)?

The process of replacing diseased bone marrow with normal functioning bone marrow.

What types of diseases is HSCT primarily used to treat?

leukemias and lymphomas.

What is one advantage of HSCT?

It allows for higher-dose therapy.

What can HSCT offer in terms of disease management?

Long-term disease control or cure.

What do hematopoietic stem cells produce?

Red blood cells, white blood cells, and platelets.

Why is HSCT performed?

To eradicate high-risk or relapsed disease and deliver high-dose chemotherapy or radiation.

What is the 'graft-versus-leukemia' effect?

Donor immune cells from a stem cell transplant attack and kill leftover leukemia cells in the patient, helping prevent the cancer from coming back.

In which situations is HSCT used for AML?

In high-risk or relapsed cases.

In which situations is HSCT used for ALL?

relapse or high risk genetics

In which situations is HSCT used for CML?

TKI failure

In which situations is HSCT used for Lymphoma?

Salvage setting (relapsed patients)

What is an autologous transplant?

A transplant where the patient's own stem cells are harvested, cryopreserved, and then infused after conditioning.

What is an allogeneic transplant?

A transplant where donor stem cells are harvested and infused into the patient.

What is the most common method for collecting stem cells?

Peripheral Blood Stem Cells collected via apheresis.

Bone Marrow Harvest

Collected directly from the donor's iliac crest when the patient is under anesthesia. (Less common)

What is the purpose of the conditioning regimen in HSCT?

To eradicate residual malignant cells, suppress the immune system, and allow stem cell engraftment.

What does conditioning in HSCT include?

High Dose of Chemotherapy & (+/-) TBI

What does engraftment refer to in HSCT?

The time required for donor cells to repopulate the marrow.

Engraftment is when transplanted stem cells successfully grow in the bone marrow and begin producing new blood cells after a hematopoietic stem cell transplant.

During the engraftment period what are pt risks?

pancytopenia, infection risk, bleeding risk.

What are common early complications of HSCT?

Infections, graft failure, and acute graft-versus-host disease (GVHD).

What is Total Body Irradiation (TBI) used for in HSCT?

It is part of the conditioning regimen for immunosuppression and to eliminate residual microscopic disease.

myeloablative vs reduction - intensity conditioning

-Myeloablative conditioning uses very high-dose therapy to completely destroy the patient's bone marrow before transplant.

-while reduced-intensity conditioning uses lower doses that suppress the marrow and rely more on the graft-versus-leukemia immune effect to eliminate cancer cells.

Early Complications?

Infections (most common), graft failure, acute graft-versus-host disease (GVHD).

What are some late effects of TBI?

Endocrine issues like hypothyroidism or gonadal dysfunction, ocular issues like cataracts, and growth failure in children, and secondary malignancies.

What is a critical consideration for patients undergoing HSCT?

Close monitoring for infections and complications.