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Deotare U, Al-Dawsari G, Couban S, Lipton JH. G-CSF-primed bone marrow as a source of stem cells for allografting: revisiting the concept. Bone Marrow Transplant 2015; 50:1150-6. [PMID: 25915812 DOI: 10.1038/bmt.2015.80] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/10/2015] [Accepted: 03/12/2015] [Indexed: 12/23/2022]
Abstract
The source of hematopoietic stem cells (HSCs) for allogeneic transplantation has evolved over the last decades, from the sole use of unstimulated bone marrow (BM) to the use of G-CSF (filgrastim)-mobilized peripheral blood, G-CSF-primed BM (G-BM) and cord blood. G-CSF-mobilized PBSC has replaced BM as the most commonly used source of allogeneic stem cells. G-BM is a source of HSCs, with studies demonstrating the safety and feasibility of this strategy with the potential for reducing GvHD, while retaining the speed of engraftment. Although the G-BM had lost its use as the optimal source of stem cells, after the widespread use of haploidentical transplantation, their use has resurfaced in 2010. This source can still be used in today's world of transplantation in aplastic anemia and other benign diseases, as well as in children donors. This study intends to review the evidence for this approach and whether this approach still has merit in the ever-evolving field of allogenic HSC transplantation. The merit of G-BM is its ability to offer speed of engraftment with reduced GvHD.
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Affiliation(s)
- U Deotare
- Allogeneic Bone Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - G Al-Dawsari
- Allogeneic Bone Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - S Couban
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - J H Lipton
- Allogeneic Bone Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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Tsirigotis PD, Resnick IB, Or R, Elad S, Zilberman I, Yoffe L, Levovic A, Miron S, Gesundheit B, Slavin S, Shapira MY. Post-hematopoietic stem cell transplantion immune-mediated cytopenias. Immunotherapy 2009; 1:39-47. [DOI: 10.2217/1750743x.1.1.39] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Immune-mediated cytopenias after allogeneic stem cell transplantation can be categorized as either alloimmune when host or donor immunity reacts against donor or host elements, respectively, or autoimmune when donor immunity reacts against donor hematopoietic tissue, owing to poorly understood mechanisms that result in severe impairment of central and peripheral tolerance. Immune cytopenias are manifested as monolineage or more rarely as bilineage cytopenias, and are usually mediated through humoral immune mechanisms. On the contrary, immune-mediated pancytopenia is a rare event with only few cases reported in the literature. The exact pathogenesis of immune pancytopenia is not well known although it is possible that cellular immunity may play a significant role. The importance of these syndromes lies in the fact that they can cause severe morbidity and mortality. Differential diagnosis from other causes of post-transplant pancytopenia is of extreme value because these disorders can respond to various treatment modalities.
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Affiliation(s)
- Panagiotis D Tsirigotis
- Department of Bone Marrow Transplantation & Cancer Immunotherapy, Hadassah – Hebrew University Medical Center, PO Box 12000, Jerusalem, 91120, Israel
| | - Igor B Resnick
- Department of Bone Marrow Transplantation & Cancer Immunotherapy, Hadassah – Hebrew University Medical Center, PO Box 12000, Jerusalem, 91120, Israel
| | - Reuven Or
- Department of Bone Marrow Transplantation & Cancer Immunotherapy, Hadassah – Hebrew University Medical Center, PO Box 12000, Jerusalem, 91120, Israel
| | - Sharon Elad
- Department of Bone Marrow Transplantation & Cancer Immunotherapy, Hadassah – Hebrew University Medical Center, PO Box 12000, Jerusalem, 91120, Israel
| | - Irina Zilberman
- Department of Bone Marrow Transplantation & Cancer Immunotherapy, Hadassah – Hebrew University Medical Center, PO Box 12000, Jerusalem, 91120, Israel
| | - Luba Yoffe
- Department of Bone Marrow Transplantation & Cancer Immunotherapy, Hadassah – Hebrew University Medical Center, PO Box 12000, Jerusalem, 91120, Israel
| | - Alexander Levovic
- Department of Bone Marrow Transplantation & Cancer Immunotherapy, Hadassah – Hebrew University Medical Center, PO Box 12000, Jerusalem, 91120, Israel
| | - Svetlana Miron
- Department of Bone Marrow Transplantation & Cancer Immunotherapy, Hadassah – Hebrew University Medical Center, PO Box 12000, Jerusalem, 91120, Israel
| | - Benjamin Gesundheit
- Department of Bone Marrow Transplantation & Cancer Immunotherapy, Hadassah – Hebrew University Medical Center, PO Box 12000, Jerusalem, 91120, Israel
| | - Shimon Slavin
- Department of Bone Marrow Transplantation & Cancer Immunotherapy, Hadassah – Hebrew University Medical Center, PO Box 12000, Jerusalem, 91120, Israel
| | - Michael-Yechiel Shapira
- Department of Bone Marrow Transplantation & Cancer Immunotherapy, Hadassah – Hebrew University Medical Center, PO Box 12000, Jerusalem, 91120, Israel
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Mihaylova N, Voynova E, Tchorbanov A, Nikolova M, Michova A, Todorov T, Srebreva L, Taskov H, Vassilev T. Selective silencing of disease-associated B-lymphocytes by chimeric molecules targeting their Fc IIb receptor. Int Immunol 2007; 20:165-75. [DOI: 10.1093/intimm/dxm133] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Brown JMY. The influence of the conditions of hematopoietic cell transplantation on infectious complications. Curr Opin Infect Dis 2005; 18:346-51. [PMID: 15985833 DOI: 10.1097/01.qco.0000172699.90525.80] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The multitude of factors that influence the risk of infection after hematopoietic cell transplantation has been further complicated by the rapid evolution of this therapy in the past 5 years. The degree to which functional immune reconstitution has been achieved reflects the equilibrium reached by the immune systems of the recipient and donor in the context of host non-hematopoietic tissue. Thus immunomodulatory influences on the recipient and the transplanted graft, both before and after hematopoietic cell transplantation, have a profound influence on the incidence and severity of infection. This review of the recent literature contributes to our understanding of how the conditions of hematopoietic cell transplantation influence the timing and nature of infectious complications. RECENT FINDINGS The main themes of published primary research from 2004 to the present focus on non-myeloablative conditioning regimens and their effects on immune reconstitution after hematopoietic cell transplantation. SUMMARY A plethora of clinical trials are ongoing, focused on the outcome after conditioning regimens designed to result in less regimen-related toxicity while preserving or enhancing the graft-versus-tumor effect. Given the infancy of these new approaches, it is not possible to make definitive statements regarding the relative risk of serious infection with each therapy. It is clear that a reduction in regimen-related non-infectious complications or mortality does not necessarily ensure a reduction in clinically significant infections. Improvements in early diagnostic and therapeutic options for these infections now bring us to an era of understanding pathogens as probes of the functional reconstitution of immunity.
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Affiliation(s)
- Janice M Y Brown
- Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California 94305, USA.
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