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Allogeneic Haemopoietic Stem Cell Transplantation

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Transplantation Surgery

Part of the book series: Springer Specialist Surgery Series ((SPECIALIST))

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Abstract

The field of allogeneic haemopoietic stem cell transplantation (HSCT) and, increasingly the use of cellular therapy, have continued to evolve since its origins in the early 1900’s. Results are improving constantly mainly due to a combination of better understanding of the underlying biological background and major advances in supportive care. New diseases and indications have been developed and with the advent of reduced toxicity conditioning, this treatment modality has been extended to older patients and to patients who in previous times would have been considered ineligible for transplantation. The preferred source of progenitor cells for HSCT has changed over the years. Traditionally, cells were harvested from the iliac crests under general anaesthesia, but recently G-CSF mobilised peripheral blood (PBSC) have been increasingly used.

The principal complication of allo-HSCT is Graft vs Host Disease (GVHD) which can occur despite aggressive immunosuppressive prophylaxis. It is a consequence of interactions between Ag-presenting cells of the recipient and mature T-cells of the donor. The median incidence of clinically significant (grade II–IV) acute GVHD (AGVHD) is about 40% but ranges from 10% to 80% according to risk factors. The overall grade of AGVHD usually predicts the clinical course. In general, grade I AGVHD has a favourable prognosis. Grade II is a moderately severe disease. Grade III is a severe, multi organ GVHD and grade IV is life threatening or fatal.

After allo-HSCT, the pattern of infections can be divided into three periods: (a) aplastic phase following the conditioning regimen until neutrophil recovery, (b) a second period from initial marrow engraftment to at least the third or fourth month, which is characterized by cell-mediated immune deficiency with decreased number and function of specific and non-specific cytotoxic cells, and (c) a late post-transplantation period from the fourth month onwards where immune reconstitution is mainly influenced by the presence and severity of chronic GVHD.

Allogeneic HSCT remains the best therapy for the control of many malignant and non-malignant diseases and for adult patients with acute leukaemia it is the treatment associated with the lowest relapse incidence.

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  1. Imperial College London, Hammersmith Hospital, London, UK

    Eduardo Olavarria

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    Nadey Hakim

  2. Başkent University, Ankara, Turkey

    Mehmet Haberal

  3. University of Virginia Medical Center, Charlottesville, VA, USA

    Daniel Maluf

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Olavarria, E. (2021). Allogeneic Haemopoietic Stem Cell Transplantation. In: Hakim, N., Haberal, M., Maluf, D. (eds) Transplantation Surgery. Springer Specialist Surgery Series. Springer, Cham. https://doi.org/10.1007/978-3-030-55244-2_17

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