Allogeneic stem cell transplantation

Allogeneic stem cell transplantation is the only curative treatment for chronic myelogenous leukemia (CML). 

Early in the diagnosis, patients should be evaluated for allogeneic stem cell transplantation. Ideal candidates include younger patients in chronic-phase CML who have an HLA-matched related or unrelated donor. 

Slavin S. Morecki S. Weiss L, Or R Donor lymphocyte infusion the use of alloreactive and tumor-reactive lymphocytes for immunotherapy of malignant and non-malignant disease in conjunction with allogeneic stem cell transplantation. J Hematother Stem Cell Res 2002 11 265-276. 

Bone marrow is the natural site of hematopoiesis and was therefore the first source of hematopoietic stem and progenitor cells. In addition to the hematopoietic cells primary stroma can also be collected simultaneously from this source. However, as the harvesting of cells from bone marrow is an invasive procedure that requires manual extraction under spinal or general anesthesia, alternative sources are preferred whenever possible, although, for allogeneic stem cell transplantation, bone marrow is still the source of choice [23]. 

Because of these immunosuppressant activities, hydroxychloroquine is used to treat some autoimmune disorders, eg, rheumatoid arthritis and systemic lupus erythematosus. It has also been used to both treat and prevent graft-versus-host disease after allogeneic stem cell transplantation. 

Pentostatin is an adenosine deaminase inhibitor primarily used as an antineoplastic agent for lymphoid malignancies, and produces a profound lymphopenia. It is now frequently used for steroid-resistant graft-versus-host disease after allogeneic stem cell transplantation, as well as in preparative regimens prior to those transplants to provide severe immunosuppression to prevent allograft rejection. 

Of 1000 allogeneic stem cell transplantations, 25 patients developed grade IV acute GVHD. The patient reported in this study is the only patient with such severe disease who, one year after the therapy, was living a normal life at home. The other 24 patients died a median of 2 months after transplantation. This case supports MSC therapy for prophylaxis and treatment of GVHD. 

In a retrospective study, renal function was investigated in patients receiving ciclosporin alone or in combination with amphotericin (24-hour infusion) after allogeneic stem-cell transplantation (112). Of 84 patients, 22 were treated with amphotericin. There was a statistically significant reduction in renal function compared with the 62 patients who received ciclosporin alone. However, renal insufficiency in all patients remained in a clinically acceptable range and was reversible in patients who survived to 1 year after transplantation. 

Furrer K, Schaffner A, Vavricka SR, Halter J, Imhof A, Schanz U. Nephrotoxicity of cyclosporine A and amphotericin B-deoxycholate as continnous infnsion in allogenic stem cell transplantation. Swiss Med Wkly 2002 132(23-24) 316-20. 

A 4.6 kg infant with Wiskott-Aldrich syndrome received an accidental overdose of busulfan during preparation for allogeneic stem cell transplantation (37). Hemodialysis was immediately performed and resulted in accelerated clearance of busulfan. There were no acute neurological or hepatic adverse effects, and after cough and by rales for 2 months pulmonary symptoms resolved. There was stable partial donor chimerism after transplantation, but the patient was well 12 months later. 

Rapoport AP, Miller Watelet LF, Linder T, Eberly S, Raubertas RF, Lipp J, Duerst R, Abboud CN, Constine L, Andrews J, Etter MA, Spear L, Powley E, Packman CH, Rowe JM, Schwertschlag U, Bedrosian C, Liesveld JL. Analysis of factors that correlate with mucositis in recipients of autologous and allogeneic stem-cell transplants. J Clin Oncol 1999 17(8) 2446-53. 

Johny AA, Clark A, Price N, Carrington D, Oakhill A, Marks DI. The use of zanamivir to treat influenza A and B infection after allogeneic stem cell transplantation. Bone Marrow Transplant 2002 29(2) 113-15. 

Severe fluid retention resistant to furosemide and fluid restriction was observed in 10 patients randomized to receive subcutaneous oprelvekin 50 pg/kg/day to prevent mucositis and acute graft-versus-host disease after allogeneic stem cell transplantation (2). One patient also had a large but reversible increase in serum transaminases. 

Antin JH, Lee SJ, Neuberg D, Alyea E, Soiffer RJ, Sonis S, Ferrara JL. A phase Fll double-blind, placebo-controlled study of recombinant human interleukin-11 for mucositis and acute GVHD prevention in allogeneic stem cell transplantation. Bone Marrow Transplant 2002 29(5) 373-7. 

I. F. Khouri, M. Albitar, R. M. Saliba, C. Ippoliti, Y. C. Ma, M. J. Keating, and R. E. Camplin, Low-dose alemtuzumab (Campath) in myeloablative allogeneic stem cell transplantation for CD52-positive malignancies decreased incidence of acute graft-versus-host-disease with unique pharmacokinetics. Bone Marrow Transplant 33 833-837 (2004). 

Bertz H, Potthoff K, Einke J. Allogeneic stem-cell transplantation from related and unrelated donors in older patients with myeloid leukemia. J ain Oncol 2003 21 1480-1484. 

Barrett J. Allogeneic stem cell transplantation for chronic myeloid lenkemia. Semin Hematol 2003 40 59-71. 

Kantarjian HM, O Brien S, Cortes JE, et al. Imatinib mesylate therapy for relapse after allogeneic stem cell transplantation for chronic myelogenous leukemia. Blood 2002 100 1590-1595. 

Pavletic ZS, Arrowsmith ER, Bierman PJ, et al. Outcome of allogeneic stem cell transplantation for B-cell CLL. Bone Marrow Transplant 2000 7 717-722. 

Dreger P, Montserrat E. Autologous and allogeneic stem cell transplantation for chronic lymphocytic leukemia. Leukemia 2002 16 985-992. 

Mackinnon S. Who may benefit from donor leucocyte infusions after allogeneic stem cell transplantation Br J Haematol 2000 10 12—17. 

Levine JE, Braun T, Penza SL, et al. Prospective trial of chemotherapy and donor leukocyte infusions for relapse of advanced myeloid malignancies after allogeneic stem cell transplantation. J CUn Oncol 2002 20 405 12. 

Junghanss C, Boeckh M, Carter RA, et al. Incidence and outcome of cytomegalovirus infections following nonmyeloablative compared with myeloablative allogeneic stem cell transplantation a matched control study. Blood 2002 99 1978-1985. 

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