Allogeneic peripheral blood stem cell transplantation. 1996

T R Spitzer
Massachusetts General Hospital, Harvard Medical School, USA.

The use of mobilized peripheral blood stem cells (PBSC) for hematopoietic reconstitution following myeloablative chemoradiotherapy has been well shown to be an effective and probably superior alternative to autologous bone marrow support. Early concerns of increased engraftment failure risk (owing to a decreased number of multipotential stem cells), increased graft vs. host disease risk (due to an excess of circulating T cells) and donor safety concerns, however, delayed efforts to use mobilized PBSC for allogeneic transplantation. Recent reports, however, have demonstrated excellent donor tolerance of G-CSF administration and yields of CD34+ progenitor cell collections. Engraftment with allogeneic peripheral blood stem cells has been rapid and sustained in several early clinical series. Surprisingly, no apparent increase in risk of moderate to severe acute graft versus host disease has occurred with unmanipulated mobilized PBSC. Despite this early promise, long-term safety concerns of administration of recombinant myeloid growth factors to normal donors have been raised. Long-term lymphohematopoietic engraftment also needs to be more conclusively demonstrated. Optimal mobilizing and collecting strategies also need to be defined to ensure donor safety and comfort. The possible roles of PBSC in the matched unrelated donor and mismatched related donor settings need to be defined before widespread adoption of mobilized PBSC as an alternative to bone marrow for allogeneic transplantation. Prospective randomized trials are recommended to definitively evaluate long term donor safety and recipient hematopoietic and immunologic reconstitution.

UI MeSH Term Description Entries
D009369 Neoplasms New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. Benign Neoplasm,Cancer,Malignant Neoplasm,Tumor,Tumors,Benign Neoplasms,Malignancy,Malignant Neoplasms,Neoplasia,Neoplasm,Neoplasms, Benign,Cancers,Malignancies,Neoplasias,Neoplasm, Benign,Neoplasm, Malignant,Neoplasms, Malignant
D002986 Clinical Trials as Topic Works about pre-planned studies of the safety, efficacy, or optimum dosage schedule (if appropriate) of one or more diagnostic, therapeutic, or prophylactic drugs, devices, or techniques selected according to predetermined criteria of eligibility and observed for predefined evidence of favorable and unfavorable effects. This concept includes clinical trials conducted both in the U.S. and in other countries. Clinical Trial as Topic
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014184 Transplantation, Homologous Transplantation between individuals of the same species. Usually refers to genetically disparate individuals in contradistinction to isogeneic transplantation for genetically identical individuals. Transplantation, Allogeneic,Allogeneic Grafting,Allogeneic Transplantation,Allografting,Homografting,Homologous Transplantation,Grafting, Allogeneic
D018380 Hematopoietic Stem Cell Transplantation Transfer of HEMATOPOIETIC STEM CELLS from BONE MARROW or BLOOD between individuals within the same species (TRANSPLANTATION, HOMOLOGOUS) or transfer within the same individual (TRANSPLANTATION, AUTOLOGOUS). Hematopoietic stem cell transplantation has been used as an alternative to BONE MARROW TRANSPLANTATION in the treatment of a variety of neoplasms. Stem Cell Transplantation, Hematopoietic,Transplantation, Hematopoietic Stem Cell

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