NCBI Bookshelf. Cham CH : Springer; Authors Norbert Claude Gorin. Parallel attempts at using fetal liver cells at that time have remained unsuccessful. There remain however several situations where and when a marrow harvest can still be of interest or even is highly recommended.
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NCBI Bookshelf. Cham CH : Springer; Authors Norbert Claude Gorin. Parallel attempts at using fetal liver cells at that time have remained unsuccessful. There remain however several situations where and when a marrow harvest can still be of interest or even is highly recommended. This chapter indicates the principal indications of BM transplantation, compares schematically the advantages of BM versus PB, and details the technique of BM harvesting.
Several studies, including prospective randomized studies, have shown in general with BM when compared to PB slower engraftment but lower incidence and lower severity of acute and chronic GVHD with in the end similar disease free and overall survivals Schmitz et al. Also, the quality of life has not been carefully analyzed Sun et al. Table The clinical significance of different HSC sources primed marrow, mobilized blood, and steady-state marrow in auto- and allo-HSCT was reviewed in Elfenbein and Sackstein Marrow is collected from the posterior superior iliac crests, usually under general anesthesia, although few teams have used sedation or locoregional anesthesia Fig.
Marrow is aspirated with bone needles with multiple holes all around, which makes collection easier and the procedure more rapid. The collection bag contains ACD anticoagulant solution and the syringes are rinsed with heparin 5. However, it should be kept in mind that old studies in the early development of BMT have indicated better results both in terms of engraftment but also decrease in NRM and RI and better outcome, with higher marrow doses Gorin et al.
Transplant in remission of acute leukemia with a high dose of marrow cells was associated with the best outcome in both children and adults. If the targeted goal cannot be achieved, additional collection can be made from the anterior iliac crests, although it is time consuming and potentially more harmful for the patient or the donor, who must be turned over with all sterile fields to be reinstalled.
Depending on the volume collected, three attitudes regarding transfusion during marrow collection may be followed: no transfusion and liquid replacement is the first option for many teams.
In rare circumstances allo-transfusion remains possible; usually two packs of concentrated red cells are enough. Another option to consider to increase the stem cell dose to infuse when marrow collection has been insufficiently productive is the addition of PBSC. Two examples of this dilemma are summarized below: 1. The NMDP analyzed in , volunteers who donated unrelated marrow from October in 42 centers Stroncek et al. Apnea during anesthesia occurred in one donor. The recommendation of this study was the duration of the collection procedure and probably the duration of anesthesia, and therefore the volume of marrow collected should be kept to a minimum, but this conclusion is to be weighed against the wish to collect stem cell doses as high as possible to ensure fast engraftment and improve outcome.
Cryopreservation and storage of a marrow in view of an allo-HSCT is possible. However, it should be kept in mind that any cryopreservation procedure, would it seem perfect, results in some measurable CFU-GM, BFU-E and many less measurable immune functions, etc. Therefore, it should be reserved to special situations when, for instance, the donor cannot be available at the very time of the transplantation procedure.
As a rule, fresh marrow is preferable to frozen marrow. The major indicator for successful BM collection is the dose collected, as discussed above, i. It is very usual to have a blood count done at the mid time of the collection to ensure proper richness.
For cryopreserved marrow, some teams routinely cryopreserve small samples in minibags or ampoules, enabling viability testing before thawing the graft usually an autograft. However, and importantly, a technical bias has been observed with ampoules since differences in cooling rates prevent ampoules from being a reliable index of HSC cryopreservation in large volumes Douay et al.
More pertinent testing consists in the evaluation of CFU-GM which represents in this setting the most reliable functional viability indicator Douay et al.
However, BM transplantation has not disappeared and is likely to persist in some limited situations and indications. Further studies may revisit and increase the choice of marrow as stem cell source. Turn recording back on. National Center for Biotechnology Information , U.
Cham CH : Springer ; Search term. Corresponding author. Decision for no transfusion with liquid replacement recommended or autotransfusion second best option or in rare cases Allo-transfusion during collection relies on the judgment of the local medical team.
Cryopreservation is the rule for auto-BMT, while it should be avoided and used only in rare specific conditions for allogeneic transplantation. BM is mandatory in children and patients with aplastic anemias. It is presently favored by some teams in the context of haploidentical transplantation. Long-term cryopreservation of human stem cells. Bone Marrow Transplant. Peripheral-blood stem cells versus bone marrow from unrelated donors. N Engl J Med. Bone marrow versus peripheral blood as the stem cell source for sibling transplants in acquired aplastic anemia: survival advantage for bone marrow in all age groups.
Diagnosis and management of acquired aplastic anemia in childhood. Blood Cells Mol Dis. Biol Blood Marrow Transplant. A technical bias: differences in cooling rates prevent ampoules from being a reliable index of stem cell cryopreservation in large volumes. Recovery of CFUGM from cryopreserved marrow and in vivo evaluation after autologous bone marrow transplantation are predictive of engraftment. Exp Hematol. Peripheral blood grafts from unrelated donors are associated with increased acute and chronic graft-versus-host disease without improved survival.
Effect of stem cell source on outcomes after unrelated donor transplantation in severe aplastic anemia. Elfenbein GJ, Sackstein R. Primed marrow for autologous and allogeneic transplantation: a review comparing primed marrow to mobilized blood and steady-state marrow. Measurable residual disease, conditioning regimen intensity and age predict outcome of allogeneic hematopoietic cell transplantation for acute myeloid leukaemia in first remission: a registry analysis of patients by the acute leukemia working party European society of blood and marrow transplantation.
Am J Hematol. Outcome of cord-blood transplantation from related and unrelated donors. Eurocord transplant group and the European blood and marrow transplantation group. Gorin NC. Collection, manipulation and freezing of haemopoietic stem cells. Clin Haematol. Autologous bone marrow transplantation for acute myelocytic leukemia in first remission: a European survey of the role of marrow purging.
Importance of marrow dose on posttransplant outcome in acute leukemia: models derived from patients autografted with mafosfamide-purged marrow at a single institution. Marrow versus peripheral blood for geno-identical allogeneic stem cell transplantation in acute myelocytic leukemia: influence of dose and stem cell source shows better outcome with rich marrow.
Higher incidence of relapse with peripheral blood rather than marrow as a source of stem cells in adults with acute myelocytic leukemia autografted during the first remission. J Clin Oncol. Ped Blood Cancer. Prospective study of nonmyeloablative, HLA-mismatched unrelated BMT with high-dose posttransplantation cyclophosphamide. Blood Adv. Comparison of patient-reported outcomes in 5-year survivors who received bone marrow vs peripheral blood unrelated donor transplantation: long-term follow-up of a randomized clinical trial.
JAMA Oncol. High-dose cyclophosphamide as single-agent, short-course prophylaxis of graft-versus-host disease. Monocytic and promyelocytic myeloid-derived suppressor cells may contribute to G-CSF-induced immune tolerance in haplo-identical allogeneic hematopoietic stem cell transplantation. Mathe G. Treatment of leukemia with allogenic bone marrow transplantation.
Brux Med. The EBMT activity survey: — Hematopoietic stem cell transplantation in Europe more than 40 transplants annually. Bone marrow versus mobilized peripheral blood stem cells in haploidentical transplants using posttransplantation cyclophosphamide. Santos GW. Bone marrow transplantation in hematologic malignancies. Current status.
Advantages of non-cryopreserved autologous hematopoietic stem cell transplantation against a cryopreserved strategy. Filgrastim-mobilized peripheral blood progenitor cells versus bone marrow transplantation for treating leukemia: 3-year results from the EBMT randomized trial.
Worse outcome and more chronic GVHD with peripheral blood progenitor cells than bone marrow in HLA-matched sibling donor transplants for young patients with severe acquired aplastic anemia. Prediction of leukemia free survival following autologous stem cell transplantation in AML. EHA 23 rd annual meeting, Stockholm, Transplantation of marrow cells from unrelated donors for treatment of high-risk acute leukemia: the effect of leukemic burden, donor HLA matching and marrow cell dose.
More chronic GvHD and non-relapse mortality after peripheral blood stem cell compared with bone marrow in hematopoietic transplantation for paediatric acute lymphoblastic leukemia: a retrospective study on behalf of the EBMT Paediatric Diseases Working Party.
Experiences of the first unrelated marrow donors in the National Marrow Donor Program. Prevalence and predictors of chronic health conditions after hematopoietic cell transplantation: a report from the bone marrow transplant survivor study. Marrow transplantation for acute non lymphoblastic leukemia in first remission.
Pretreatment with anti-thymocyte globulin versus no anti-thymocyte globulin in patients with haematological malignancies undergoing haemopoietic cell transplantation from unrelated donors: a randomised, controlled, open-label, phase 3, multicentre trial. Lancet Oncol. Chapter
The EBMT Handbook
It seems that you're in Germany. We have a dedicated site for Germany. Editors: Carreras , E. Consisting of 93 chapters, it has been written by leading experts in the field. Discussing all types of stem cell and bone marrow transplantation, including haplo-identical stem cell and cord blood transplantation, it also covers the indications for transplantation, the management of early and late complications as well as the new and rapidly evolving field of cellular therapies. Only valid for books with an ebook version. Springer Reference Works are not included.
EBMT Handbook of HSCT
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