Treatment stem cell transplants

Allogeneic hematopoietic stem cell transplantation (HSCT) has been used in the treatment of pediatric AML in first complete remission. In most clinical trials, the availability of HLA-matched sibling donors determined whether patients underwent HSCT as postremission treatment. To facilitate this process, it is important to obtain HLA typing on all younger patients with AML and siblings shortly after diagnosis. Patients who do not have an HLA-matched sibling will proceed to postremission therapy. 

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

The primary goal in the treatment of multiple myeloma is to decrease tumor burden and minimize complications associated with the disease. A watch and wait approach is an option for asymptomatic patients who have no lytic lesions in the bone. Once symptoms occur, treatment is required. Chemotherapy can be used to reduce tumor burden in patients with symptomatic disease, but increasingly, immunomodula-tors such as thalidomide and dexamethasone are initial therapy. Almost all patients will become refractory to initial treatment and will require the use of salvage therapies such as bortezomib. Autologous stem cell transplantation prolongs overall survival in patients who can tolerate high-dose chemotherapy and may be the treatment of choice for many patients. 

Hematopoietic stem cell transplants as treatment for glial disease 513... 

A drawback for stem cell therapy is the problem of cell rejection due to the host s immune system recognizing the cells as foreign. This rejection issue has to be overcome to ensure stem cell therapy is a viable treatment. Recently, French scientists reported on research progress in stem cell transplants for curing children with sickle cell anemia. A mix of antirejection drugs was used to suppress rejection of the new stem cells. 

For the treatment of patients with esophageal candidiasis, and for prophylaxis of Candida infections in patients undergoing hematopoietic stem cell transplantation (HSCT). 

Cell treatments are as simple and routine as a blood transfusion and as uncertain as the use of specialized cells produced in the laboratory from adult or embryonic stem cells. The history of blood transfusion suggests that it will take a lot of research and perhaps a long time to solve the mysteries of these stem cells. From the first sheep blood transfusion, it took several hundred years for physicians to learn how to transfuse blood safely. Even today, it takes constant vigilance and research to make sure a blood transfusion is safe, a lesson learned tragically in the early years of the AIDS epidemic. Blood stem cell transplants, though life-saving in some situations, can pose the risk of potentially deadly graft versus... 

Harter C, Schulze B, Goldschmidt H, Benner A, Geiss HK, Hoppe-Tichy T et al. Piperachlin/tazobactam vs ceftazidime in the treatment of neutropenic fever in patients with acute leukemia or foUowing autologous peripheral blood stem cell transplantation a prospective randomized trial. Bone Marrow Transplant 2006 37 373-79. 

Fig. 1. Outline of treatment strategy applied in the ALL-Berlin-Frankfurt-Munster (BFM) 95 study (1995-2000). Patients were assigned to standard-risk (SR), intermediate-risk (MR) and high-risk (HR) subgroups. Elements containing 6-mercaptopurine (6-MP) or 6-thioguanine (6-TG) are indicated in grey. Abbreviations PRED-GR, prednisone good response PRED-PR, prednisone poor response DEXA, dexamethasone VCR, vincristine DNR, daunorubicin HD-MTX, high-dose methotrexate LD-ARA-C, low-dose cytarabine SCT, stem cell transplantation.

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. 

Recombinant thrombopoietin is still an investigational agent. The primary focus of current clinical trials is for the treatment of chemotherapy-induced thrombocytopenia and thrombocytopenia accompanying hematologic stem cell transplantation. Other trials are looking into the possibility of administering thrombopoietin to normal donors in order to increase the number of cells recovered by platelet apheresis. Approval of the latter application will require that thrombopoietin be shown to have an excellent short- and long-term safety profile. 

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