The non-myeloablative transplant approaches hold promise in reducing the morbidity and mortality associated with conventional high-dose chemoradiation therapy, and they allow allogeneic transplants in elderly or medically infirm patients who are at present not candidates for transplantation.
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What is the difference between myeloablative and non myeloablative stem cell transplants?
Difference From Myeloablative Stem Cell Transplants Non-myeloablative transplants differ primarily in what happens prior to the transplant. Compared to myeloablative transplants, mini-transplants use much lower and less toxic doses of chemotherapy and radiation, followed by the infusion of donor stem cells.
Is conventional myeloablative transplantation a high risk treatment for hematologic malignancies?
Despite these obvious benefits, the regimen related toxicity from the myeloablative conditioning makes conventional myeloablative transplantation a high risk treatment option for the majority of patients with hematologic malignancies due to older age, comorbidities, and an extensive treatment history.2
What is myeloablation or myeloablative therapy?
This is called myeloablation or myeloablative therapy. Soon after treatment, stem cells are given (transplanted) to replace those that were destroyed. The replacement stem cells are given into a vein, much like a blood transfusion.
What are my options for consolidation therapy for multiple myeloma?
For younger patients (typically those under 60), the main options for consolidation therapy are: 1 Several cycles of chemo with high-dose cytarabine (ara-C) (sometimes known as HiDAC) 2 Allogeneic (donor) stem cell transplant 3 Autologous stem cell transplant
What is a non-myeloablative transplant?
Non-myeloablative (reduced-intensity) transplant uses a lower dose of chemotherapy and no radiation, followed by an infusion of disease-fighting stem cells from a donor whose tissue type matches your own. The chemotherapy suppresses the immune system to prevent graft rejection.
Who is a good candidate for bone marrow transplant?
People who need a bone marrow transplant may have any of several serious conditions, including: Acute lymphocytic leukemia. Acute myelogenous leukemia (AML) Adrenoleukodystrophy.
Who is a candidate for allogeneic stem cell transplant?
Healthcare providers use allogeneic stem cell transplantation to replace unhealthy cells that cause conditions, including: Acute myeloid leukemia (AML): People in remission from AML may be candidates for allogeneic stem cell transplantation.
What is the difference between myeloablative and Nonmyeloablative?
Non-myeloablative transplants differ primarily in what happens prior to the transplant. Compared to myeloablative transplants, mini-transplants use much lower and less toxic doses of chemotherapy and radiation, followed by the infusion of donor stem cells.
Who is a good candidate for stem cell therapy?
In theory, any condition in which there is tissue degeneration can be a potential candidate for stem cell therapies, including Parkinson's disease, spinal cord injury, stroke, burns, heart disease, Type 1 diabetes, osteoarthritis, rheumatoid arthritis, muscular dystrophy and liver diseases.
Who is the most likely match for bone marrow?
Donating stem cells or bone marrow to a relative A brother or sister is most likely to be a match. There is a 1 in 4 chance of your cells matching. This is called a matched related donor (MRD) transplant. Anyone else in the family is unlikely to match.
When would you use allogeneic stem cell transplant?
An allogeneic stem cell transplant is most often used to treat blood cancers, such as leukemia and lymphoma, and certain types of blood or immune system disorders.
When is stem cell transplant recommended?
A stem cell transplant is used for treatment when: Your body cannot make the blood cells it needs because your bone marrow or stem cells have failed. Your bone marrow or blood cells have become diseased. In this case you need healthy stem cells to replace the diseased bone marrow/stem cells.
Why is allogeneic important?
One of the benefits of allogeneic stem cell transplantation is that after the donated cells engraft in the patient, they create a new immune system. The donated cells produce white blood cells that attack any remaining cancer cells in the patient's body.
What is the goal of myeloablative therapy?
High-dose chemotherapy that kills cells in the bone marrow, including cancer cells. It lowers the number of normal blood-forming cells in the bone marrow, and can cause severe side effects.
What is myeloablative conditioning regimen?
MYELOABLATIVE CONDITIONING REGIMENS (MA) The term myeloablation refers to the administration of total body irradiation (TBI) and/or alkylating agents , at doses which will not allow autologous hematologic recovery.
What does Myeloablative mean?
Listen to pronunciation. (MY-eh-loh-a-BLAY-shun) A severe form of myelosuppression. Myelosuppression is a condition in which bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelets.
Why are non-myeloablative transplants better tolerated?
Because they use less aggressive, less toxic chemotherapy and/or radiation, non-myeloablative transplants tend to be better tolerated by your body. The direct side effects of the preparative regimen are clearly less. IBMT physicians often perform non-myeloablative transplants completely as an outpatient therapy.
What is a non-myeloablative transplant?
Non-Myeloablative transplant, also called "mini-transplant," "transplant-lite," or "reduced intensity transplant," is a stem cell transplant from a donor (allogeneic) that uses a less aggressive combination of chemotherapy and/or radiation to prepare the patient for the transplant. In the "conventional" allogeneic stem cell transplants, ...
How do stem cells fight cancer?
Stem cell transplants with donor cells can fight cancer in two ways. The chemotherapy and/or radiation given prior to the transplant (preparative regimen or conditioning regimen) often destroys a lot of the cancer cells.
What is the goal of chemo for stem cell transplants?
In the "conventional" allogeneic stem cell transplants, the goals of the preparative chemotherapy/radiation are to kill as many cancer cells as possible and to suppress the immune system of the patient to allow the donor cells to grow.
Can IBMT be performed as an outpatient?
IBMT physicians often perform non-myeloablative transplants completely as an outpatient therapy. The less toxic nature of the chemotherapy used for non-myeloablative transplants allows this treatment to be utilized in patients who are not candidates for "conventional" allogeneic transplants.
Can cancer be treated with allogeneic transplants?
In addition, not all cancers that can be treated with allogeneic transplants have shown clear graft-versus-tumor effects. Thus, such cancers would not be good candidates for non-myeloablative transplants.
Can you transplant from partially matched donors?
Transplants from partially matched related donors have only rarely been attempted. It is feared that the non-myeloablative preparative therapy will not be sufficient to suppress the immune system of the patient; failure of the new donor cells to grow would be the result.
What type of cancer is treated with non-myeloablative transplants?
Non-myeloablative transplants have been used to treat different types of blood cancers, including Hodgkin and non-Hodgkin lymphoma, myeloma, and leukemia. Response rates have varied in studies.
What is the difference between a myeloablative and a mini transplant?
Compared to myeloablative transplants, mini-transplants use much lower and less toxic doses of chemotherapy and radiation , followed by the infusion of donor stem cells . This process takes advantage of the graft vs malignancy effect while being less toxic to ...
What is a non-myeloablative stem cell transplant?
Non-myeloablative stem cell transplants, or “mini-transplants,” are a relatively new type of allogeneic peripheral stem cell transplant which do not require ablating (wiping out) the marrow to the degree of traditional stem cell transplants. They are also called reduced-intensity allogeneic transplants.
Can non-myeloablative stem cells be used for cancer?
Non-myeloablative stem cell transplant may also have a role in treating patients who are in remission with high-risk cancer , such as acute myelogenous leukemia, or who have had a relapse after a previous stem cell transplant. Researchers are also looking at the success of non-myeloablative stem cell transplant in patients with solid tumor cancers, ...
Is transplant good for older people?
This type of transplant may be a good option for patients who are older in age or who have other medical conditions that would make them unable to tolerate the toxic chemotherapy effects of regular transplants. 2
What are the two immunological barriers that must be overcome in a major histocompatibility complex identical HS
In the major histocompatibility complex identical HSCT setting, two immunological barriers must be overcome. One is the rejection barrier , or host-versus-graft reaction ; the other is the graft-versus-host reaction. Both reactions are effected by T lymphocytes, suggesting that agents given after HSCT to control graft-versus-host reactions might also be able to modulate host-versus-graft reactions. The latter feature would allow minimizing the high-dose therapy given before HSCT for host immunosuppression.
What are the differences between GVL and CML?
There are major differences among malignancies in their susceptibility to GVL effects and, hence, their sensitivity to nonmyeloablative allogeneic transplants (see Table 2 ). CML has been the disease in which GVL effects are best documented. 4 The majority of patients who relapse into chronic phase following an allogeneic transplant achieve durable complete remission with DLI. Indolent lymphoid malignancies also appear very sensitive to graft-versus-malignancy effects. Allogeneic transplants are associated with a substantially lower relapse rate than purged autologous transplants. Selected patients with CLL or low-grade lymphoma have responded to DLI or modification of immunosuppressive therapy. 5 In preliminary studies of nonablative allogeneic transplants, many patients with low-grade lymphoma, mantle cell lymphoma or CLL have achieved durable remissions. 6 These highly sensitive malignancies share several common characteristics. These are indolent disorders that are not immediately life threatening, thus giving time for a graft-versus-malignancy effect to develop. In CML and lymphoma, the malignant cells are derived from antigen presenting cells, B-lymphocytes in the case of lymphoid malignancies and dendritic cells that can be generated from CML. 7 Their responsiveness to GVL may in part relate to effective in vivo antigen presentation.
What is the name of the drug used in chemo?
Most chemotherapy based nonablative preparative regimens have utilized purine analogs and alkylating agents, usually cyclophosphamide, melphalan or busulfan. Purine analogs (fludarabine, pentostatin or cladribine) have activity against a wide range of hematologic malignancies and are sufficiently immunosuppressive in standard doses to allow engraftment of HLA compatible hematopoietic progenitor cells.
Do nonablative regimens eliminate hematopoiesis?
Nonablative regimens do not eradicate host hematopoies is and immunity, and autologous recovery occurs if the graft is rejected. Many regimens proposed to reduce toxicity still require transplantation to be safely administered, and graft rejection results in prolonged pancytopenia; these regimens should be considered reduced toxicity ablative regimens. Increased intensity of immunosuppression is necessary for engraftment of unrelated donor or haploidentical transplants.
Which is the most effective treatment for MS?
The consensus among most Hematologist’s until recently has been that if you have a progressive form of MS (PPMS or SPMS), Myeloablative HSCT has been the most effective form of treatment.
What are the lymphocytes responsible for?
The lymphocytes are responsible for the underlying nerve damage/ destruction to the myelin. These are the white blood cells that, in normal circumstances, destroy bacteria and other harmful substances in the blood. In terms of MS, these usually helpful cells become ‘rogue.’.
How long does HSCT chemotherapy take?
Myeloablative HSCT most commonly incorporates a BEAM (Carmustine, Cytarabine, Etoposide, Melphalan) chemotherapy protocol. The chemotherapy takes place over six days. ATG can be supplementary, for a couple of days, rather than as an essential lymphoablation. Many HSCT doctors consider Myeloablative to be the most ‘reliable’ form of HSCT.
Is myeloablative HSCT reliable?
Many HSCT doctors consider Myeloablative to be the most ‘reliable’ form of HSCT. The protocol destroys the lymphocytes more completely and ultimately reduces the chance of any of the ‘baddies” surviving! Myeloablative HSCT involves using higher doses of chemotherapy, which is harder on the body.
Does gentler chemotherapy have a lower mortality rate?
This “gentler” chemotherapy has a lower mortality rate. However, the trade-off is that compared with the Myeloablative protocol, there remains a proportion of patients (20-25%) that fail to halt their disease progression.
Is HSCT more dangerous than myeloablative?
On the other hand, the procedure is much less harsh on the body than Mye loablative HSCT. Lymphocytes are “diminished” to a threshold level below which autoimmune-mediated damage occurs. With this form of HSCT, the bone marrow remains intact, making the treatment less dangerous. The patient can recover more quickly.
Does myeloablative HSCT treat MS?
Ironically, there are currently no places that offer Myeloablative HSCT to treat progressive cases of MS. The facilities that use Myleoblative HSCT are all signed up to the EBMT and treat only Relapse Remitting forms of MS. In the past few years, many new facilities performing HSCT have opened up.
What is APL post remission?
Consolidation (post-remission therapy) The acute promyelocytic leukemia (APL) subtype of AML is treated differently. Treatment for AML usually needs to start as quickly as possible after it is diagnosed because it can progress very quickly. Sometimes another type of treatment needs to be started even before the chemo has had a chance to work.
What happens when blood cells recover from leukemia?
When the blood cell counts recover, the doctor will again check cells in a bone marrow sample to see if the leukemia is in remission. Remission induction usually does not destroy all the leukemia cells, and a small number often remain.
How long does it take for leukemia to go down?
This is called leukostasis. Chemo can take a few days to lower the number of leukemia cells in the blood.
How long does it take for blood count to go down after chemo?
Blood counts tend to stay low for a few weeks. About a week after chemo is done, the doctor will do a bone marrow biopsy. It should show few bone marrow cells ( hypocellular bone marrow) and only a small portion of blasts (making up no more than 5% of the bone marrow) for the leukemia to be considered in remission.
Can you take midostaurin with chemo?
For patients whose leukemia cells have an FLT3 gene mutation, the targeted therapy drug midostaurin (Rydapt) might be given along with chemo. This drug is taken twice daily as a pill. For patients whose leukemia cells have the CD33 protein, the targeted drug gemtuzumab ozogamicin (Mylotarg) might be added to chemo.
Should stem cells be given for leukemia?
Still others feel that stem cell transplants should be given if the leukemia is likely to come back based on certain gene or chromosome changes. Research in this area continues to study which AML patients get the most benefit from stem cell transplant and which type of transplant is best in each situation.
Can older people tolerate intensive consolidation?
Older patients or those in poor health may not be able to tolerate intensive consolidation treatment. Often, giving them more intensive therapy raises the risk of serious side effects (including treatment-related death) without providing much more of a benefit. These patients may be treated with:
How many autologous transplants are there in a row?
Doing 2 autologous transplants in a row is known as a tandem transplant or a double autologous transplant. In this type of transplant, the patient gets 2 courses of high-dose chemo as myeloablative therapy, each followed by a transplant of their own stem cells. All of the stem cells needed are collected before the first high-dose chemo treatment, and half of them are used for each transplant. Usually, the 2 courses of chemo are given within 6 months. The second one is given after the patient recovers from the first one.
What are the two types of transplants?
There are 2 main types of transplants. They are named based on who donates the stem cells. Autologous: Auto means self. The stem cells in autologous transplants come from the same person who will get the transplant, so the patient is their own donor.
What is a BMT transplant?
Bone marrow transplant (BMT) Peripheral blood stem cell transplant. Cord blood transplant. They can all be called hematopoietic stem cell transplants. In a typical stem cell transplant for cancer, very high doses of chemo are used, sometimes along with radiation therapy, to try to kill all the cancer cells. This treatment also kills the stem cells ...
What are the risks of allogeneic stem cell transplants?
Risks of allogeneic stem cell transplants: The transplant, or graft, might not take – that is, the transplanted donor stem cells could die or be destroyed by the patient’s body before settling in the bone marrow.
What is the first step in autologous stem cell transplant?
Autologous stem cell transplants. In this type of transplant, the first step is to remove or harvest your own stem cells. Your stem cells are removed from either your bone marrow or your blood, and then frozen.
What is the procedure called when you get a bone marrow transplant?
Depending on where the stem cells come from, the transplant procedure may be called: They can all be called hematopoietic stem cell transplants.
Why are white people better at stem cell transplants?
This is because ethnic groups have differing HLA types, and in the past there was less diversity in donor registries, or fewer non-White donors.