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Engineering Hematopoietic Grafts Using Elutriation and Positive Cell Selection to Reduce GVHD

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Advances in Allogeneic Hematopoietic Stem Cell Transplantation

Part of the book series: Cancer Treatment and Research ((CTAR,volume 101))

Abstract

Over the last two decades, allogeneic bone marrow transplantation (BMT) has provided a means of delivering potentially curative therapy to patients with hematologic malignancies (1). Unfortunately, approximately 70% of allogeneic BMT patients receiving unmodified (wherein marrow is immediately infused) grafts develop acute graft-vs-host disease (GVHD) with one third of these patients rapidly succumbing to this complication (2,3). Of patients surviving more than 100 days, half will later develop chronic GVHD which has an attendant mortality of almost 50% (4). This incidence increases still further for those individuals who receive an HLA mismatched or unrelated donor graft. It was initially believed that the use of allogeneic peripheral blood stem cells (PBSC) would reduce the incidence of GVHD. Unfortunately, both acute and chronic GVHD are as prevalent (or even greater in the case of chronic GVHD) with PBSC as that seen with bone marrow as the stem cell source (5,6). The lack of suitable donors and high morbidity has popularized other high dose chemotherapy/ stem cell rescue approaches such as autologous BMT and peripheral blood stem cell (PBSC) transplantation. To date, allogeneic BMT still generates the highest cure rates, largely due to its inherent anti-tumor [or graft-vs-leukemia (GVL)] properties which results in low relapse rates (7,8). The dilemma often facing the transplant physician is whether to suggest that a patient undergo a less morbid transplant approach with a higher relapse risk or accept the greater mortality risk of allogeneic BMT in hopes of achieving a cure. Improvements in supportive care and Similar advances must be achieved in the allogeneic setting for this to remain a viable option, regardless of it’s curative potential.

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  1. The Johns Hopkins Oncology Center, Rm 804, 550 N. Broadway Avenue, Baltimore, 21205, MD, USA

    Stephen J. Noga M.D., Ph.D.

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  1. Northwestern University Medical Center, Chicago, USA

    Richard K. Burt  & Mary M. Brush  & 

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Noga, S.J. (1999). Engineering Hematopoietic Grafts Using Elutriation and Positive Cell Selection to Reduce GVHD. In: Burt, R.K., Brush, M.M. (eds) Advances in Allogeneic Hematopoietic Stem Cell Transplantation. Cancer Treatment and Research, vol 101. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-4987-1_14

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  • DOI: https://doi.org/10.1007/978-1-4615-4987-1_14

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