Autologous vs Allogeneic Stem Cell Transplantation ...
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Description

Autologous vs Allogeneic Stem Cell Transplantation 

AUTOLOGOUS TRANSPLANT - Transplant of self (patient)-mobilized and harvested stem cells

 • Goals:  Reconstitute hematopoesis after highpotency chemo to kill all cells in BM (tumor /normal); intent is mostly curative except for myeloma (goal deep remission)

 • Indications: 1st relapsed lymphomas (40-50% 5YS) & all myelomas (35% 5YS); also for

consolidation tx in amyloidosis, relapsed Waldenström, germ cell tumors

 • Source of cells: Usually peripheral blood stem cells (PBSC) – less invasive, more rapid engraftment than BM harvest

 • Global timeline: Mobilization (G-CSF; chemo) → harvest cells from self → high-dose chemo to kill disease → transplant → recovery of counts in 7-10 days (engraftment)→ monitor for infectious & transplant-related complications

 • Graft-versus-host disease (GVHD): No 

 • Graft-versus-tumor (GVT) effect: No 

 • Immunosupression: No 

 • Time to engraftment: 7-10 days 

ALLOGENEIC TRANSPLANT - Transplant of non-self (donor) stem cells

 • Goals: Reconstitute hematopoiesis after high dose chemo and graft-versus-tumor (GVT) effect to kill high-risk disease or treat profound marrow failure (e.g. aplastic anemia); always curative intent

 • Indications: High-risk AML (40-60% 5YS) or AML >age 60 (ara-C consolidation contraindicated), ALL (40-50% 5YS), MDS (45% 5YS), TKI-resistant CML. Indolent relapsed lymphomas, autoimmune dz (SCID, aplastic anemia)

 • Source of cells: Traditionally BM, now more commonly PBSC. Umbilical cord blood also used (delays engraftment)

 • Global timeline: Donor HLA matching → mobilize and harvest donor cells → ablate patient immune system/marrow → transplant → engraftment in 14-30 days (depending on transplant type) → monitor for infectious, transplant, and graftversus-host (GVHD) complications

 • Graft-versus-host disease (GVHD): Yes, skin, liver, GI most commonly affected. Acute (w/in 6 months, peri-transplant mortality) and/or chronic (> 3 months, morbidity/mortality months-to-years later)

 • Graft-versus-tumor (GVT) effect: Yes (therapeutic mechanism – goal for donor T cells to engraft and attack host tumor cells→ GVT effect)

 • Immunosupression: Yes (sometimes for 1-2 years)

 • Time to engraftment: 2-4 wks, depends on donor (time: cord blood > BM > PB)



#Autologous #Allogeneic #StemCell #Transplantation #HSCT #diagnosis #comparison #table
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