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What is hematopoietic stem cell transplant?
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Hematopoietic stem cell transplant is a type of procedure that is routinely used to treat patients with cancer as well as other nonmalignant blood and immune disorders, according to the NIH.
The process involves IV infusion of either autologous or allogeneic stem cells for the reestablishment of hematopoietic function in patients with damaged stem cells. The patient’s stem cells are infused back into the body to replace diseased stem cells and provide new cells to help attack the cancer cells or diseased cells.
This procedure additionally allows for the patient to be able to receive and endure high-dose radiotherapy or chemotherapy. The various conditions HSCT is used to treat include acute and chronic leukemia, Hodgkin’s and non-Hodgkin’s lymphoma, multiple myeloma, aplastic anemia, plasma cell disorders and primary amyloidosis.
The procedure
Before a patient undergoes HSCT, there are several evaluation tests that to assess their overall health as well as the disease itself. If a patient is approved to undergo HSCT, a central-line catheter is inserted into the neck or chest so that the new stem cells and other medications can be infused into the body.
Patients are required to receive a chemotherapy or radiotherapy conditioning regimen before the actual transplant is to take place. The patient may experience side effects associated with this regimen, such as bleeding, nausea and vomiting, diarrhea, infection, hair loss, infertility or organ failure.
The next step is to infuse the new stem cells into the body through the central line. During this process, the patient does not normally experience any pain or discomfort.
Once the new stem cells begin to create new cells within the body, known as engraftment, the patient remains under close medical watch to ensure there are no complications or infections acquired. Patients may additionally require periodic transfusions of red blood cells and platelets until their stem cells produce enough cells on its own.
Risks of HSCT
Although some patients may not experience many side effects from treatment, others have significant complications, which may lead to hospitalization or even death.
These complications may include stem cell failure, graft-versus-host disease, damage to organs, infections, infertility, risk for fractures and the risk for the development of new cancers. These complications may further lead to depression, anxiety, delirium and distress.
There are also long-term effects of HSCT. A patient may eventually acquire avascular joint necrosis, secondary malignancies, restrictive pulmonary disease, renal insufficiency, osteopenia and neurocognitive effects.
On the horizon
Many advancements have been made in the field of HSCT. Looking ahead, future research includes secondary haplo-HSCT following relapse with an initial allogeneic HSCT, haplo-identical HSCT compared with chemotherapy in adults with acute lymphoblastic leukemia, and a study examining the effect of an experimental agent on decreasing the incidence and intensity of graft-versus-host disease after HSCT.
For more information:
http://stemcells.nih.gov/info/scireport/pages/chapter5.aspx