The three options for HSCT include use of bone marrow (BM), peripheral blood stem cells (PBSC), and cord blood (CB). The biology of the graft and the immunological effects differ between the sources of stem cells.8
Bone marrow (BM)
- the first source of stem cells8
- harvested from the iliac crests of a donor under general anaesthetic8
- in Australia in 2012:2
- bone marrow was the cell source for 14.16% (78/551) of allogeneic / syngeneic transplants
- bone marrow was the source for <1% (1/1016) of autologous transplants.
Peripheral blood stem cells (PBSC)
- offers advantages over BM in collection procedure:8
- no anaesthesia
- less invasive procedure
- no hospitalisation
- more chronic GVHD (cGVHD) after PBSC use with unrelated donor transplants for leukaemia8
- survival advantage with PBSC vs. BM8
- in Australia in 2012:2
- peripheral blood was the cell source for 73.1% (403/551) of allogeneic / syngeneic transplants
- peripheral blood was the source for >99% (1015/1016) of autologous transplants.
Cord blood (CB)
- increasing use in the last decade
- advantages include:6, 8
- no apparent risk to donors
- no prolonged screening process
- immunologically immature T cells allow for cord blood to be transplanted in mismatched donors without the significant risk of GVHD.
- Disadvantages include:6, 8
- prolonged immune reconstitution
- low cell dose
- potential for less GVT
- limited long term data
- multiple ethical, legal, and financial considerations remain.
In Australia in 2012:2
- cord blood was the cell source for 6.7% (37/551) of allogeneic / syngeneic transplants
- double cord blood was the cell source for 5.3% (29/551) of allogeneic / syngeneic transplants
- of the allogeneic cord blood transplants, 39 were in recipients aged 0-15 and 25 were in recipients aged over 16.
Discuss circumstances where BM may be used rather than PBSC.
Outline the components of an education session, including preparation, details of the procedure, and potential risks / effects for a donor undergoing:
- PBSC collection
- BM collection.
Review the medical notes of a recipient of an autologous PBSC transplant, and:
- Outline significant points in their treatment trajectory
- Discuss how PBSC collection process differs in the context of autologous and allogeneic transplants.
Access the ABMDR Cord Blood Information website, and summarise the key points to provide information to a person affected by cancer, and/or their relatives.