Peripheral stem cell transplantation

Peripheral blood stem cell transplantation (PBSCT), also called "Peripheral stem cell support",[1] is a method of replacing blood-forming stem cells. Stem cells can be destroyed through cancer treatments such as chemotherapy or radiation, as well as any blood-related diseases, such as leukemia, lymphoma, neuroblastoma and multiple myeloma.[2] PBSCT is now a much more common procedure than its bone marrow harvest equivalent due to the ease and less invasive nature of the procedure.[3][4] Studies suggest that PBSCT has a better outcome in terms of the number of hematopoietic stem cell (CD34+ cells) yield.[5]

Peripheral stem cell transplantation
A bag of freshly transplanted peripheral blood stem cells
Specialtyhematology

Immature hematopoietic stem cells in the circulating blood that are similar to those in the bone marrow are collected by apheresis from a donor (PBSC collection). The product is then administered intravenously to the patient after treatment. The administered hematopoietic stem cells then migrate to the recipient's bone marrow, through a process known as stem cell homing, where the transplanted cells override the previous bone marrow. This allows the bone marrow to recover, proliferate and continue producing healthy blood cells.

The transplantation may be autologous (an individual's own blood cells), allogeneic (blood cells donated by someone else with matching HLA), or syngeneic (blood cells donated by an identical twin). The apheresis procedure typically lasts for 4–6 hours, depending on the blood volume of the donor.[6]

Preparation prior to PBSC Collection

Granulocyte colony stimulating factor (GCSF) are naturally occurring glycoproteins that stimulate white blood cell proliferation. Filgrastim is a synthetic form of GCSF produced in E.coli.[7] PBSC donors are given a course of GCSF prior to PBSC collection. The increase in white blood cell proliferation as a result of the Filgrastim ensures a better results from the donation. The course is usually given over a 4-day period prior to PBSC collection.[8] The most common side effects of Filgrastim are bone, joint, back, arm, leg, mouth, throat, and muscle pain.[9] Additionally, headache, nausea, vomiting, dizziness, fatigue, rash, loss of appetite, and difficulty falling or staying asleep are common.[9]

Complications

Since allogeneic PBSCT involves transformation of blood between different individuals, this naturally carries more complications than autologous PBSCT.[10] For example, calculations must be made to ensure consistency in the amount of total blood volume between the donor and recipient. If the total blood volume of the donor is less than that of the recipient (such as when a child is donating to an adult), multiple PBSCT sessions may be required for adequate collection. Performing such a collection in a single setting could result in risks such as hypovolemia, which could lead to cardiac arrest and death. Health care providers must exercise careful precaution when considering donor-recipient matching in allogeneic PBSCT.[11]

History

An early example of a successful peripheral stem cell transplant was carried out in the wake of the 1999 Tokaimura nuclear accident. One of the two technicians who received the highest dose of radiation was treated with PBSCT in an attempt to restore his destroyed immune system. Cells from the patient's sister's bone marrow were administered, and in the following weeks successfully began dividing and differentiating into white blood cells. However, several weeks later, the cells were found to have been mutated by the radiation still present within the patient's body, and were observed carrying out autoimmune responses.[12] Later studies on the incident and subsequent use of PBSCT found that the transplant had also induced neoendothelialization of the aortic endothelium.[13]

References
  1. "Dictionary of Cancer Terms". 2011-02-02. Retrieved 2 March 2012.
  2. "Frequently asked questions about stem cell research". Mayo Clinic. Retrieved 2021-04-15.
  3. "Stem Cell Transplant (Peripheral Blood, Bone Marrow, and Cord Blood Transplants)". Retrieved 4 March 2012.
  4. "Peripheral Blood Stem Cell Harvest". Retrieved 4 March 2012.
  5. Singhal, S; Powles, R; Kulkarni, S; Treleaven, J; Sirohi, B; Millar, B; Shepherd, V; Saso, R; Rowland, A; Long, S; Cabral, S; Horton, C; Mehta, J (March 2000). "Comparison of marrow and blood cell yields from the same donors in a double-blind, randomized study of allogeneic marrow vs blood stem cell transplantation". Bone Marrow Transplantation. 25 (5): 501–5. doi:10.1038/sj.bmt.1702173. PMID 10713626.
  6. "Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation". 2005-09-09.
  7. Welte, K; Gabrilove, J; Bronchud, MH; Platzer, E; Morstyn, G (Sep 15, 1996). "Filgrastim (r-metHuG-CSF): the first 10 years". Blood. 88 (6): 1907–29. doi:10.1182/blood.V88.6.1907.bloodjournal8861907. PMID 8822908.
  8. "G-CSF Administration".
  9. "Filgrastim Injection: MedlinePlus Drug Information". medlineplus.gov. Retrieved 2021-04-15.
  10. Cutler, C; Antin, JH (2001). "Peripheral blood stem cells for allogeneic transplantation: a review". Stem Cells. 19 (2): 108–17. doi:10.1634/stemcells.19-2-108. PMID 11239165.
  11. Sevilla, J; Plaza, SF; González-Vicent, M; Lassaletta, A; Ramírez, M; Madero, L; Díaz, MA (2007). "PBSC collection in extremely low weight infants: a single-center experience". Cytotherapy. 9 (4): 356–61. doi:10.1080/14653240701320270. PMID 17573611.
  12. Nagayama, Hitomi; Ooi, Jun; Tomonari, Akira; Iseki, Tohru; Arinobu, Tojo; Tani, Kenzaburo; Takahashi, Tsuneo A.; Yamashita, Naohide; Asano, Shigetaka (2002). "Severe Immune Dysfunction after Lethal Neutron Irradiation in a JCO Nuclear Facility Accident Victim". International Journal of Hematology. 76 (2): 157–164. doi:10.1007/BF02982579. PMID 12215015. S2CID 9152173.
  13. Suzuki, T.; Nishida, M.; Futami, S.; Fukino, K.; Amaki, T.; Aizawa, K.; Chiba, S.; Hirai, H.; Maekawa, K.; Nagai, R. (2003). "Neoendothelialization after peripheral blood stem cell transplantation in humans: a case report of a Tokaimura nuclear accident victim". Cardiovascular Research. NCBI. 58 (2): 487–92. doi:10.1016/s0008-6363(02)00780-0. PMID 12757883.

 This article incorporates public domain material from Dictionary of Cancer Terms. U.S. National Cancer Institute.

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