Medical Archive

Introduction

The hematopoietic stem cell

Categories of HCT

The transplant preparative regimen

The transplant procedure

• Chemotherapy prior to the transplantation
• Exam
  • HLA-A, B, C, D, DRB1, DQB1
  • ??? ??? ??: 1/4 (1-0.75ⁿ)

## Autologous transplantation

1. G-CSF?? hematopoietic growth factor? 4-5?? ????.
2. 1~2?? 4-h pheresis session? ?? stem cell? ??
3. ????? ??, transplantation of >2.5 × 10^6 CD34 cells per kilogram
4. In the 10–20% of patients who fail to mobilize sufficient CD34+ cells with growth factor alone, the addition of plerixafor, an antagonist of CXCR4, may be useful.
5. When compared to the use of autologous marrow, use of peripheral blood stem cells results in more rapid hematopoietic recovery.

??: allogenic? ?? GVHD, graft rejection? ??.
??: autologous stem cell can be contaminated with tumor cells

Engraftment and immune reconstitution

Complications following hematopoietic cell transplant

Early direct chemoradiotoxicities

Late direct chemoradiotoxicities

Graft failure

Graft-versus-host disease; GVHD

• Epidemiology
  • Up to 50% of patients with BM transplantation from matched siblings.
  • Up to 20% of high-risk patients
• Common cause
  • Allogenic BMT
  • Transplantation of organs rich in lymphocytes (e.g. liver)
  • Transfusion of non-irradiated blood
• Clinical manifestations
  • Acute, within 100 days
    • Dermatitis – maculopapular rash in palms and soles
    • Enterocolitis – diarrhea, abdominal pain, melena
    • Hepatitis – ?LFT
  • Chronic, after 100 days
    • ?????????? skin rash ?
• Differential diagnosis
  • Common infections such as C.difficile & CMV must be ruled out.
  • Diagnosed by biopsy
• Treatment
  • Acute: ??? steroid, ATG
  • Chronic: ??? self-limited
• Complications
  • ??, GVHD, ???? 

Clinical Stage	Skin	Liver – Bilirubin, ?mol/L (mg/dL)	Gut
1	Rash <25% body surface	34–51 (2–3)	Diarrhea 500–1000 mL/d
2	Rash 25–50% body surface	51–103 (3–6)	Diarrhea 1000–1500 mL/d
3	Generalized erythroderma	103–257 (6–15)	Diarrhea >1500 mL/d
4	Desquamation and bullae	>257 (>15)	Ileus
Overall Clinical Grade	Skin Stage	Liver Stage	Gut Stage
I	1–2	0	0
II	1–3	1	1
III	1–3	2–3	2–3
IV	2–4	2–4	2–4

Infection

C138 Infections in Transplant Recipients

Organism	Agent	Approach
Bacterial	Levofloxacin	750 mg PO or IV daily
Fungal	Fluconazole	400 mg PO qd to day 75 posttransplant
Pneumocystiscarinii	Trimethoprim-sulfamethoxazole	1 double-strength tablet PO bid 2 days/week until day 180 or owimmunosuppression
Viral
Herpes simplex	Acyclovir	800 mg PO bid to day 30
Varicella-zoster	Acyclovir	800 mg PO bid to day 365
Cytomegalovirus	Ganciclovir	5 mg/kg IV bid for 7 days, then 5 (mg/kg)/d 5 days/week to day 100

Treatment of specific diseases using hematopoietic cell transplantation

Nonmalignant diseases

Immunodeficiency disorders

Aplastic anemia

Hemoglobinopathies

Other nonmalignant diseases

Malignant diseases

Acute leukemia

Chronic leukemia

Myelodysplasia and myeloproliferative disorders

Lymphoma

Myeloma

Solid tumors

Posttransplant relapse