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Holtick, U., et al
|Subject Keywords:||Bone marrow, Peripheral blood stem cell transplantation, Adult patient, Haematological malignancy Survival, Incidence of relapse, Non-relapse mortality, Disease-free survival, Transplant-related mortality, Incidence of GvHD, Engraftment|
Stem cell transplantation is an important treatment option for individuals with blood cancers (haematological malignancies). During the procedure, blood-forming (stem) cells, derived from the bone marrow, peripheral blood or umbilical cord blood of a healthy donor, are transplanted into a person with a blood cancer. The aim is to replenish the recipient's body with healthy cells after treatment with conditioning regimens such as chemotherapy or radiation (or both). Peripheral blood stem cells and bone marrow stem cells are the standard stem cell sources used in adults. The most successful transplantations occur when stem cells are transplanted from a healthy donor whose tissue is genetically compatible with that of the recipient (matched related donor). If no matched donor can be identified, it is possible to transplant cells from a matched unrelated donor or from donors carrying certain mismatches. In principle, the higher the degree of genetic mismatch, the higher the risk of severe transplant-related complications, especially graft-versus-host disease (GvHD), in which a donor's white blood cells (T cells) attack the recipient's healthy tissues.
Peripheral blood versus bone marrow stem cells
Peripheral blood stem cells are collected after the donor has received a drug that acts to mobilise stem cells from the bone marrow to the peripheral blood. Bone marrow stem cell donation involves the removal of stem cells from the pelvic bone of the donor under general anaesthesia. Donor convenience as well as logistic reasons favour peripheral blood stem cell donation.
This review addresses the question of which stem cell source - bone marrow or peripheral blood - is the most suitable for individuals undergoing stem cell transplantation.
Clinical results from several studies have been published comparing the use of bone marrow stem cells and peripheral blood stem cells in individuals with haematological malignancies. In most of these studies, the rates at which stem cells received during transplantation start to grow and make new blood cells (known as engraftment) have been shown to be faster following the transplantation of peripheral blood stem cells (PBSCT) than following transplantation of bone marrow stem cells (BMT) platelets. Some studies have reported PBSCT to be associated with a higher risk of developing GvHD than BMT. GvHD is associated with a lower risk of relapse, reflecting the capability of the immune response to simultaneously attack the malignant cells (Graft versus Malignacy effect). On the other hand, GvHD can be an important driver of transplant-related mortality and morbidity. Disease-free and overall survival have usually been reported not to differ between PBSCT and BMT. A systematic review from 2005, based on data from individual recipients, could not identify a preferred stem cell source and was largely based on data from the late 1990s. Since then, transplant indications and strategies, as well as supportive care measures, have changed substantially.
|Rights:||© The Cochrane Collaboration|
Holtick, U., et al. (2014) Bone marrow versus peripheral blood allogeneic haematopoietic stem cell transplantation for haematological malignancies in adults [Online]. Available from: http://www.thehealthwell.info/node/763359 [Accessed: 30th March 2017].