Skip to main content Accessibility help
×
Hostname: page-component-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-29T17:31:36.564Z Has data issue: false hasContentIssue false

2 - Types of transplantation

Published online by Cambridge University Press:  05 November 2013

Joseph H. Antin
Affiliation:
Dana-Farber Cancer Institute, Boston
Deborah Yolin Raley
Affiliation:
Dana-Farber Cancer Institute, Boston
Get access

Summary

Autologous transplantation

Autologous stem celltransplantation (or stem cell rescue) allows the administration of high-dosechemotherapy or chemoradiotherapy and eliminates myelotoxicity as adose-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 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, relapse occurs usually 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 showing that marrow involvement can contribute to relapse.

  • Allogeneic transplantation

    Allogeneic transplantationuses stem cells from either a family member or an unrelated donor. Sourcesinclude 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 (GVHD).

  • Haploidentical transplantation (from family members matched at one HLA haplotype, that is, potentially as few as 6/12 loci) is considered investigational.

  • Conditioning regimens vary in intensity and are categorized by the duration of cytopenia and on the requirement for stem cell support. There are three levels of intensity: nonmyeloablative (NMA), reduced-intensity conditioning (RIC), and high-intensity or myeloablative conditioning (MAC).

  • Type
    Chapter
    Information
    Publisher: Cambridge University Press
    Print publication year: 2013

    Access options

    Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

    References

    Bacigalupo, A, Ballen, K, Rizzo, D, et al. Defining the intensity of conditioning regimens: working definitions. Biol Blood Marrow Transplant 2009; 15: 1628–33.CrossRefGoogle ScholarPubMed

    Save book to Kindle

    To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

    Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

    Find out more about the Kindle Personal Document Service.

    Available formats
    ×

    Save book to Dropbox

    To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

    Available formats
    ×

    Save book to Google Drive

    To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

    Available formats
    ×