In this type of transplant, the first step is to remove or harvest your own stem cells. The stem cells in allogeneic transplants are from a person other than the patient, either a matched related or unrelated donor. The stem cells in autologous transplants come from the same person who will get the transplant, so the patient is their own donor. They are named based on who donates the stem cells. The goal is that over time, the transplanted cells will settle in the bone marrow, where they will begin to grow and make healthy new blood cells. The replacement stem cells are given into a vein, much like a blood transfusion. Soon after treatment, blood stem cells are given (transplanted) to replace those that were destroyed. This is called myeloablation or myeloablative therapy. This treatment also kills the stem cells in the bone marrow. In a typical stem cell transplant for cancer, a person first gets very high doses of chemo, sometimes along with radiation therapy, to try to kill all the cancer cells. Peripheral blood stem cell transplant (PBSCT)Īll of these can also be called hematopoietic stem cell transplants.Depending on where the stem cells come from, the transplant procedure may go by different names: Allo-RIC has to be considered an effective therapeutic approach for patients who have had treatment failure with a previous autologous hematopoietic stem cell transplantation.Stem cell transplants are used to put blood stem cells back into the body after the bone marrow has been destroyed by disease, chemotherapy (chemo), or radiation. Both responses observed after the development of GVHD and DLI may suggest a graft-versus-HL effect. Results are better in patients allografted in sensitive disease. These data suggest that allo-RIC is feasible in heavily pretreated HL patients and has an acceptable early transplant-related mortality. For patients with failure of a prior autologous hematopoietic stem cell transplantation, results were especially good for those who experienced late relapses (>/=12 months: 2-year OS and PFS were 75% +/- 16% and 70% +/- 18%, respectively). Refractoriness to chemotherapy was the only adverse prognostic factor for both OS (63% +/- 12% versus 35% +/- 13% P =. Overall survival (OS) and progression-free survival (PFS) were 48% +/- 10% and 32% +/- 10% at 2 years, respectively. The response rate after DLI was 54% (3 complete remissions and 3 partial remissions). Eleven patients received donor lymphocyte infusions (DLIs) for disease relapse. The response rate 3 months after the allo-RIC was 67% (21 complete remissions and 6 partial remissions). Chronic GVHD developed in 17 (45%) of the 31 evaluable patients. Acute GVHD developed in 18 patients (45%). One-year transplant-related mortality was 25%. Five patients (12%) died from early transplant-related mortality (before day +100 after allo-RIC). Twenty patients (50%) were allografted in resistant relapse, and 38 patients received hematopoietic cells from an HLA-identical sibling. Twenty-one patients (53%) had received >2 lines of chemotherapy, 23 patients (58%) had received radiotherapy, and 29 patients (73%) had experienced treatment failure with a previous autologous stem cell transplantation. Forty patients with relapsed or refractory HL were homogeneously treated with an RIC protocol (fludarabine 150 mg/m(2) intravenously plus melphalan 140 mg/m(2) intravenously) and cyclosporin A and methotrexate as graft-versus-host disease (GVHD) prophylaxis. We report the results of reduced-intensity conditioning allogeneic stem cell transplantation (allo-RIC) in patients with advanced Hodgkin lymphoma (HL).
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