Technology and Application of Blood Stem Cells

Dong-Tsamn Lin

《Journal of Genetics and Molecular Biology》 12卷4期 (2001/12) Pp. 223-224

https://doi.org/10.30047/JGMB.200112.0019

並列摘要

Blood stem cells transplant (BCT) has been used to treat a variety of diseases for at least four decades. Blood stem cells can derive from bone marrow, peripheral blood or placenta. The donor sources can be siblings, relatives or unrelated donors. According to similarity of human leukocyte antigens (HLA), it can be divided into fullmatch, partial-match or haplo-identical. There are two types of BCT, one is autologous and the other is allogeneic. Stem cells from bone marrow can be collected by multiple needle punctures over iliac bones in sterile operation room under general anesthesia. Peripheral blood stem cells harvesting can be done by blood cell separator in blood bank after mobilization by high dose chemotherapy with or without colony-stimulating facfors (CSF) or CSF alone within two consecutive days. In autologous setting, stem cells can be collected first and cryopreserved until transplant. In allogeneic transplant, stem cells will be harvested and then infused into patient without storage, usually. Cord blood stem cells were collected immediately after delivery from placenta and cryopreseved for future use. The pitfalls of bone marrow collection are 1. need general anesthesia 2. painful 3. unable to collect in some patients. On the contrary, these are the advantages of peripheral blood stem cells, but it still has some disadvantages such as 1. non-mobilizer 2. safety of injecting CSF to normal donors. Cord blood can be available once the HLA-match has been found. One more advantage is its lower incidence of graft-versus-host disease (GVHD) if HLA is partial-match or even haplo-identical. But, its largest pitfall is limited cells amount.
Blood stem cells can be processed further, e.g. removal of red cells, plasma or both for major, minor or both incompatibilities, T-cell depletion, to prevent severe GVHD I mis-match allogeneic transplant CD34 positive selection in order to avoid tumor cells contamination in autologous transplant. En vivo expansion is also a hot topic in order to solve the problem of limited cells amount.
Concerning about indications of BCT, autologous transplant can play an important role to rescue patients from intensive chemotherapy for certain acute leukemias, Hodgkin’s and non-Hodgkin’s lymphomas, multiple myeloma and selected solid tumors. Allogeneic transplant is peformed for acute and chronic leukemias, Hodgkin’s and non-Hodgkin’s lymphomas, myelo-fibrosis, severe aplastic anemia, myelo-dysplastic syndrome, congenital immuno-deficiencies and thalassemia major. Some successful results have also been reported with allogeneic transplant for osteopetrosis, thrombasthenia and other inherited metabolic abnormalities.