A report on Hematopoietic stem cell transplantation

Bone marrow transplant
The spectrum of target antigens associated with tumor immunity and alloimmunity after allogeneic HSCT: Host-derived T and B cells can be induced to recognize tumor-associated antigens, whereas donor-derived B and T cells can recognize both tumor-associated antigens and alloantigens.
Bone marrow harvest
Peripheral blood stem cells

Transplantation of multipotent hematopoietic stem cells, usually derived from bone marrow, peripheral blood, or umbilical cord blood in order to replicate inside of a patient and to produce additional normal blood cells.

- Hematopoietic stem cell transplantation
Bone marrow transplant

66 related topics with Alpha

Overall

A woman being treated with docetaxel chemotherapy for breast cancer. Cold mittens and cold booties are placed on her hands and feet to reduce harm to her nails.

Chemotherapy

14 links

Type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents) as part of a standardized chemotherapy regimen.

Type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents) as part of a standardized chemotherapy regimen.

A woman being treated with docetaxel chemotherapy for breast cancer. Cold mittens and cold booties are placed on her hands and feet to reduce harm to her nails.
Dose response relationship of cell killing by chemotherapeutic drugs on normal and cancer cells. At high doses the percentage of normal and cancer cells killed is very similar. For this reason, doses are chosen where anti-tumour activity exceeds normal cell death.
5-FU dose management results in significantly better response and survival rates versus BSA dosing.
5-FU dose management avoids serious side effects experienced with BSA dosing
Two DNA bases that are cross-linked by a nitrogen mustard. Different nitrogen mustards will have different chemical groups (R). The nitrogen mustards most commonly alkylate the N7 nitrogen of guanine (as shown here) but other atoms can be alkylated.
Deoxycytidine (left) and two anti-metabolite drugs (center and right); gemcitabine and decitabine. The drugs are very similar but they have subtle differences in their chemical structure.
Vinca alkaloids prevent the assembly of microtubules, whereas taxanes prevent their disassembly. Both mechanisms cause defective mitosis.
Topoisomerase I and II Inhibitors
Two girls with acute lymphoblastic leukemia receiving chemotherapy. The girl on the left has a central venous catheter inserted in her neck. The girl on the right has a peripheral venous catheter. The arm board stabilizes the arm during needle insertion. Anti-cancer IV drip is seen at top right.
The four phases of the cell cycle. G1 – the initial growth phase. S – the phase in which DNA is synthesised. G2 – the second growth phase in preparation for cell division. M – mitosis; where the cell divides to produce two daughter cells that continue the cell cycle.
Sidney Farber did pioneering work in chemotherapy
Scanning electron micrograph of mesoporous silica; a type of nanoparticle used in the delivery of chemotherapeutic drugs.

In very severe myelosuppression, which occurs in some regimens, almost all the bone marrow stem cells (cells that produce white and red blood cells) are destroyed, meaning allogenic or autologous bone marrow cell transplants are necessary.

Radiation therapy of the pelvis, using a Varian Clinac iX linear accelerator. Lasers and a mould under the legs are used to determine exact position.

Radiation therapy

7 links

Therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator.

Therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator.

Radiation therapy of the pelvis, using a Varian Clinac iX linear accelerator. Lasers and a mould under the legs are used to determine exact position.
Radiation therapy for a patient with a diffuse intrinsic pontine glioma, with radiation dose color-coded.
Histopathology of radiation cystitis, including atypical stromal cells (“radiation fibroblasts”).
The beam's eye view of the radiotherapy portal on the hand's surface with the lead shield cut-out placed in the machine's gantry
A teletherapy radiation capsule composed of the following:
Varian TrueBeam Linear Accelerator, used for delivering IMRT
A SAVI brachytherapy device
X-ray treatment of tuberculosis in 1910. Before the 1920s, the hazards of radiation were not understood, and it was used to treat a wide range of diseases.

Total body irradiation (TBI) is a radiation therapy technique used to prepare the body to receive a bone marrow transplant.

A section of bone marrow tissue
(Prussian blue-stained)

Bone marrow

7 links

Semi-solid tissue found within the spongy portions of bones.

Semi-solid tissue found within the spongy portions of bones.

A section of bone marrow tissue
(Prussian blue-stained)
Bone marrow aspirate showing normal "trilineage hematopoiesis": myelomonocytic cells (an eosinophil myelocyte marked), erythroid cells (an orthochromatic erythroblast marked), and megakaryocytic cells.
Hematopoietic precursor cells: promyelocyte in the center, two metamyelocytes next to it and band cells from a bone marrow aspirate.
A Wright's-stained bone marrow aspirate smear from a patient with leukemia.
A bone marrow harvest in progress.
The preferred sites for the procedure
260px

Bone marrow transplants can be conducted to treat severe diseases of the bone marrow, including certain forms of cancer such as leukemia.

A Wright's stained bone marrow aspirate smear from a person with B-cell acute lymphoblastic leukemia.

Leukemia

7 links

Group of blood cancers that usually begin in the bone marrow and result in high numbers of abnormal blood cells.

Group of blood cancers that usually begin in the bone marrow and result in high numbers of abnormal blood cells.

A Wright's stained bone marrow aspirate smear from a person with B-cell acute lymphoblastic leukemia.
Common symptoms of chronic or acute leukemia
The increase in white blood cells in leukemia.
Deaths due to leukemia per million persons in 2012
Rudolf Virchow

Treatment may involve some combination of chemotherapy, radiation therapy, targeted therapy, and bone marrow transplant, in addition to supportive care and palliative care as needed.

Blood smear from a person with myelodysplastic syndrome. A hypogranular neutrophil with a pseudo-Pelger-Huet nucleus is shown. There are also abnormally shaped red blood cells, in part related to removal of the spleen.

Myelodysplastic syndrome

7 links

One of a group of cancers in which immature blood cells in the bone marrow do not mature, so do not become healthy blood cells.

One of a group of cancers in which immature blood cells in the bone marrow do not mature, so do not become healthy blood cells.

Blood smear from a person with myelodysplastic syndrome. A hypogranular neutrophil with a pseudo-Pelger-Huet nucleus is shown. There are also abnormally shaped red blood cells, in part related to removal of the spleen.
Enlarged spleen due to myelodysplastic syndrome; CT scan coronal section, spleen in red, left kidney in green

Treatments may include supportive care, drug therapy, and hematopoietic stem cell transplantation.

Mouse colon impacted by acute graft-versus-host disease.

Graft-versus-host disease

4 links

Syndrome, characterized by inflammation in different organs.

Syndrome, characterized by inflammation in different organs.

Mouse colon impacted by acute graft-versus-host disease.
Micrographs of grades of skin graft-versus-host disease: Ranging from grade I GvHR (with minimal vacuolization in the epidermis) to grade II GvHR (with vacuolization and dyskeratotic bodies) to grade III GvHR (with sub epidermal cleft formation) and finally to grade IV GvHR (with separation of the dermis from the epidermis).
GvHD pathology

GvHD is commonly associated with bone marrow transplants and stem cell transplants.

Reenactment of the first heart transplant, performed in South Africa in 1967.

Organ transplantation

3 links

Medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ.

Medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ.

Reenactment of the first heart transplant, performed in South Africa in 1967.
Diagram of an exchange between otherwise incompatible pairs
Distribution of solid organ transplantation activity, by region used in the Global Burden of Disease Study, 2006–2011
Alexis Carrel: 1912's Nobel Prize for his work on organ transplantation.

Sometimes an autograft is done to remove the tissue and then treat it or the person before returning it (examples include stem cell autograft and storing blood in advance of surgery).

Aplastic anemia

4 links

Disease in which the body fails to produce blood cells in sufficient numbers.

Disease in which the body fails to produce blood cells in sufficient numbers.

Hematopoietic stem cell transplantation is also used, especially for patients under 30 years of age with a related, matched marrow donor.

Fanconi anemia has an autosomal recessive pattern of inheritance.

Fanconi anemia

4 links

Rare genetic disease resulting in impaired response to DNA damage.

Rare genetic disease resulting in impaired response to DNA damage.

Fanconi anemia has an autosomal recessive pattern of inheritance.
Recombinational repair of DNA double-strand damage - some key steps. ATM (ATM) is a protein kinase that is recruited and activated by DNA double-strand breaks. DNA double-strand damages also activate the Fanconi anemia core complex (FANCA/B/C/E/F/G/L/M).  The FA core complex monoubiquitinates the downstream targets FANCD2 and FANCI.   ATM activates (phosphorylates) CHEK2 and FANCD2  CHEK2 phosphorylates BRCA1.   Ubiquinated FANCD2 complexes with BRCA1 and RAD51.  The PALB2 protein acts as a hub, bringing together BRCA1, BRCA2 and RAD51 at the site of a DNA double-strand break, and also binds to RAD51C, a member of the RAD51 paralog complex RAD51B-RAD51C-RAD51D-XRCC2 (BCDX2).  The BCDX2 complex is responsible for RAD51 recruitment or stabilization at damage sites.  RAD51 plays a major role in homologous recombinational repair of DNA during double strand break repair. In this process, an ATP dependent DNA strand exchange takes place in which a single strand invades base-paired strands of homologous DNA molecules.  RAD51 is involved in the search for homology and strand pairing stages of the process.

Treatment with androgens and hematopoietic (blood cell) growth factors can help bone marrow failure temporarily, but the long-term treatment is bone marrow transplant if a donor is available.

Micrograph showing Hodgkin lymphoma (Field stain)

Hodgkin lymphoma

3 links

Type of lymphoma, in which cancer originates from a specific type of white blood cell called lymphocytes, where multinucleated Reed–Sternberg cells (RS cells) are present in the patient's lymph nodes.

Type of lymphoma, in which cancer originates from a specific type of white blood cell called lymphocytes, where multinucleated Reed–Sternberg cells (RS cells) are present in the patient's lymph nodes.

Micrograph showing Hodgkin lymphoma (Field stain)
Lymph node biopsy showing Hodgkin lymphoma, mixed-cellularity type
CT image of a 46-year-old person with Hodgkin lymphoma, image at neck height. On the left side of the person's neck enlarged lymph nodes are visible (marked in red).
Micrograph of a classic Reed–Sternberg cell
Micrograph showing a "popcorn cell", the Reed–Sternberg cell variant seen in nodular lymphocyte predominant Hodgkin lymphoma. H&E stain
Photograph of Hodgkin's disease from a 1938 medical textbook
Stage 1 Hodgkin lymphoma
Stage 2 Hodgkin lymphoma
Stage 3 Hodgkin lymphoma
Stage 4 Hodgkin lymphoma
Age-standardized death from lymphomas and multiple myeloma per 100,000 inhabitants in 2004 
no data
less than 1.8
1.8–3.6
3.6–5.4
5.4–7.2
7.2–9
9–10.8
10.8–12.6
12.6–14.4
14.4–16.2
16.2–18
18–19.8
more than 19.8

Hodgkin lymphoma may be treated with chemotherapy, radiation therapy, and stem cell transplantation.