Hematopoetic Cell Transplant (HCT)

image205

HCT

Hematopoietic cell transplantation (also called bone marrow transplantation or stem cell transplantation), is a type of treatment for cancer (and a few other conditions as well), and involves the intravenous infusion of autologous or allogeneic stem cells collected from bone marrow, peripheral blood, or umbilical cord blood to reestablish hematopoietic function in patients whose bone marrow or immune system is damaged or defective. 

 
 

The term HCT has supplanted the term bone marrow transplantation (BMT) as hematopoietic cells can be obtained from several sources other than bone marrow, e.g., peripheral blood and umbilical cord blood 

 
 

Currently, the major categories of HCT are: 

(1) autologous HSCT

(2) allogeneic HSCT

 
 The choice of autologous vs. allogeneic depends on the availability of a donor and the underlying condition. Each type has specific indications, limitations, and complications because tumor burden always needs to be as  low as possible pre-transplant to have good chances of success, for both allo and auto transplant.

image206

Autologous HCT:

The cells are obtained from the patient’s own bone marrow or peripheral blood and re-infused following conditioning. Auto-HSCT facilitates the prompt reconstitution of a markedly depleted or ablated marrow following very aggressive chemotherapy and radiotherapy intended to eradicate hematologic and non-hematologic malignancies. 

 
 

Current indications for autologous HCT include: 

(1) Refractory or relapsed Hodgkin and aggressive non-Hodgkin lymphoma and germ cell tumors, (2) Plasma cell myeloma after induction therapy, (3) Mantle cell lymphoma in first remission, and (4) Acute myeloid leukemia in second remission if an allogeneic bone marrow donor is unavailable. Less common indications include (1) Low-grade B-cell lymphomas, (2) Breast cancer, and (3) Autoimmune disease

image207

Allogeneic HCT:

In allogeneic HCT the donor cells come from another donor. It is used for both hematopoietic malignancies and non-malignant conditions, and as salvage therapy in patients not responding to standard chemotherapy or radiotherapy, or following failure of autologous HCT.

 
 

The most frequent indications:

(1) Acute myeloid leukemia (about one-third of cases), (2) Acute lymphoblastic leukemia and myeloproliferative/myelodysplastic disorders (each about 10–15 %), (3) non-Hodgkin lymphomas, (4) Chronic myeloid leukemias, other leukemias, (5) Aplastic anemia and other non-malignant conditions, (6) Plasma cell myeloma and (7) Hodgkin lymphoma 

References:

Maedler-Kron C, Marcus VA, Michel RP. Hematopoietic Stem Cell Transplantation. InPathology of Transplantation 2016 (pp. 401-449). Springer, Cham. 


Vaughan W, Seshadri T, Bridges M, Keating A. The principles and overview of autologous hematopoietic stem cell transplantation. InHematopoietic Stem Cell Transplantation 2009 (pp. 23-45). Springer, Boston, MA. 


D'Souza A, Fretham C. Current Uses and Outcomes of Hematopoietic Cell Transplantation (HCT): CIBMTR Summary Slides, 2017. Available at: http://www.cibmtr.org