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Stem Cell Transplantation

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Information About the Field of Stem Cell Transplantation

What Is a Stem Cell Transplantation?

Stem cell transplantation is a treatment method for cancers of the blood and lymphatic system. Stem cells are blood-forming progenitor cells or parent cells that originate in the bone marrow and then mature into specialized blood cells. These mature cells include white blood cells, red blood cells, and platelets, which clot the blood.

After maturation in the bone marrow, the finished cells migrate into the bloodstream. In the case of cancer of the blood or lymphatic system, degeneration of various blood cells or the already migrated lymphocytes occurs. As a result, malignant cells are formed, which make up the blood cancer, also called leukemia or lymphoma, the cancer of the lymph glands.

When these cancers are not sufficiently treatable by chemotherapy and radiation, stem cell transplantation may be considered in some cases, which means that the autologous or allogeneic stem cells are removed and allocated to the patient after chemotherapy. This causes a renewal of the bone marrow and the immune system to cure patients if the therapy is successful.

When Is a Stem Cell Transplantation Performed?

There are two reasons for performing a stem cell transplant. First, the donation can replace malignant bone marrow to cure existing cancer. In addition, stem cell treatment can restore bone marrow that has been destroyed as a concomitant of tumor disease as a result of high-dose chemotherapy or other blood or autoimmune diseases.

What Types Are There?

Stem cells can be used by the patient himself or by a donor. If the patient's stem cells are taken, this is called autologous stem cell transplantation. It is usually done to treat the destroyed bone marrow as a result of the necessary chemotherapeutic treatment.

On the other hand, allogeneic stem cell transplantation means that a donor is sought who matches the blood characteristics of the recipient. Thus, there is a possibility to transfer the stem cells of the donor to the patient. Furthermore, it is supposed to heal the cancer disease, as donated stem cells grow in the bone marrow and form new, healthy bone marrow. The term 'allo' comes from Greek and means' different, foreign.'

Autologous Versus Allogeneic Stem Cell Transplantation

Autologous stem cell transplantation can be used mainly for lymphoma and multiple myeloma. In preparation for the collection, chemotherapy is also administered to destroy abnormal cells in the bone marrow. After the stem cells are harvested and frozen, the necessary high-dose chemotherapy can treat cancer. After that, the stored stem cells can be returned to the patient to allow the attacked bone marrow to recover with some interval. However, after replacing the autologous stem cells in the patient, there remains a residual risk that degenerated cells among the stored stem cells may have survived and caused a tumor recurrence.

Allogeneic stem cell donation is primarily used to cure cancer or tumor recurrence when the patient's bone marrow is interspersed with malignant cells to the extent that only an external donation can lead to recovery. This occurs with forms of cancer in which the bone marrow is diseased. These diseases include leukemias in particular, but congenital blood diseases and immune deficiencies can also be treated in this way.

What Is the Procedure of a Stem Cell Transplantation?

The stem cells can be collected by puncture from the bone marrow or by blood collection. In the case of collection from the venous system, the stem cells must be stimulated beforehand to be flushed out into the bloodstream. For this purpose, growth factors are injected under the patient's skin. The stem cells are now filtered out of the blood; this process is also called leukapheresis.

Autologous stem cells are frozen and stored to be used after chemotherapy has been completed. In the case of foreign donation, the patient is prepared for transplantation by high-dose chemotherapy and/or total body irradiation. If possible, the entire bone marrow and thus the diseased cells should be destroyed in this way. This process is called conditioning and serves to improve the implantation of the cells. These are transferred to the recipient in an infusion lasting two to four hours following the donation.

The vulnerable phase of stem cell transplantation follows. This phase, also known as the aplasia phase, is characterized by the fact that the patient has no immune defenses of his own and is therefore highly susceptible to infection. It takes about three weeks for the foreign cells to settle and grow in the bone marrow. During this time, extreme caution is required, and many protective measures must be taken.

Patients remain inpatient in a sterile unit and are fed a low-germ diet to prevent infection. Likewise, blood transfusions of red and white blood cells may be necessary. Approximately one to two months of inpatient therapy takes place, followed by close outpatient monitoring and continued protective measures to minimize infection. Only after about a year is the immune system functional enough for patients to resume their everyday life. Nevertheless, long-term immunosuppression with medication is usually required after a foreign donation to prevent rejection reactions.

Prognosis and Experience

Stem cell transplantation is considered when the benefits are greater than the risks of treatment. Similarly, the treatment should achieve a better outcome than other available treatment options. Although allogeneic stem cell transplantation brings a chance of cure, it is a very intensive and risky treatment. Rejection reactions can occur, which can mean the patient's death due to severe physical impairment. The risk of infection due to immunosuppression can also have serious consequences. Due to the completely suppressed immune system, harmless infections can take on serious proportions.

In general, therapy has improved significantly in recent years so that many patients can be helped. However, the risk of dying from the treatment or cancer itself is highest in the first year after transplantation. Overall, the prognosis depends on the condition of the patient, the underlying disease, and many other factors and can hardly be generalized.

Which Doctors and Clinics are Specialized in Stem Cell Transplantation?

Stem cell transplants are performed in clinics for internal medicine and hematology. In addition, there are usually special centers for stem cell transplantation in which interdisciplinary teams participate in the treatment of patients.

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