AUTOLOGOUS TRANSPLANTATION

Autologous stem cell transplantation (or stem cell rescue) allows the administration of high-dose chemotherapy or chemoradiotherapy and eliminates myelotoxicity as a dose-limiting complication.

• The stem cell source can be either mobilized peripheral blood stem cells or bone marrow.

• Autologous transplantation is commonly used for lymphomas and myeloma and less commonly for leukemia.

• Autologous transplantation is also used for testicular cancer.

• In patients with leukemia and lymphoma, there is considerable concern over the reinfusion of occult tumor cells along with the marrow or peripheral blood progenitors. Therefore, numerous attempts to purge tumor cells from the stem cells have been undertaken. However, it is unclear whether such manipulation affects relapse, and tumor purging is not routinely performed. Arguments against purging include its cost and labor intensiveness. Moreover, for lymphoma and solid tumors, patients usually relapse at sites of prior bulky disease, suggesting that residual tumor within the recipient, not tumor in the stem cell product, is the primary contributor to relapse. Arguments in favor of purging include gene marking studies that show that marrow involvement can contribute to relapse.

ALLOGENEIC TRANSPLANTATION

Allogeneic transplantation uses stem cells from either a family member or an unrelated donor. Sources include bone marrow, peripheral blood, or umbilical cord blood.

• Typically fully matched donors are preferred, but various degrees of incompatibility can be tolerated with appropriate attention to prevention of rejection and graft-versus-host disease.

• […]