Bone Marrow Transplantation
Return to Q&A Library Treating graft-vs-host disease
Collecting stem cells for future BMT
Cord blood transplantation
Peripheral blood stem cell transplant vs. regular BMT
Statistics on "mini-transplants"
Platelet counts after BMT
ANC response after transplant
Treating graft-vs-host disease
How is graft-vs-host disease treated in people who have had BMT for aplastic anemia, myelodysplastic syndromes, and paroxysmal nocturnal hemoglobinuria?
Patients with these disorders receive the same graft-vs-host prophylaxis (prevention) as do patients with other diagnoses. This means immune suppression and/or T-cell depletion of the marrow. The strength of the suppression depends upon the type of donor and the degree of match. There is no one regimen that is considered as a "standard."
Graft-vs-host disease (GVHD) is treated with powerful immune suppressive medicines including steroids, methotrexate, mycophenolate, rapamycin, cyclosporine, and tacrolimus (Prograf), to name some of the more commonly used agents. Also used are ATG (antithymocyte globulin) and pentostatin (Nipent). There are different approaches to acute and chronic GVHD.
Contact the BMT InofNet for general information on graft-vs-host disease and other issues associate with bone marrow transplants. BMT InfoNet can be reached at 888.597.7674 or www.bmtinfonet.org.
Collecting stem cells for future BMT
Can aplastic anemia patients treated successfully with ATG and currently in remission then have their functioning stem cells collected and stored for future use in BMT with their own stem cells?
That is an interesting question. Technically this is possible. However, patients who are "in remission" from aplastic anemia have fewer Cells in the body that develop into other cells. There are two main sources of stem cells. Embryonic stem cells come from human embryos and are used in medical research. Adult stem cells in the body repair and maintain the organ or tissue in which they are found. Blood-forming (hemapoietic) stem cells are found in the bone marrow. These cells make copies of themselves and develop into red cells, white cells, and platelets.
stem cells than normal. In addition, the cells that they do have are not normal in their function. Finally it is not clear that using a person's own stem cells would be wise since the body turned against them in the first place.
Cord blood transplantation
Is cord blood used for bone marrow transplantation in aplastic anemia and MDS patients – children or adults? How does it compare to other sources of stem cells – success rates, risk of graft-versus-host disease, other risks?
Cord blood has been used for these diseases with good success. There is some question as to whether graft rejection rates are higher than expected in patients with aplastic anemia who receive cord blood transplants. This is being tested prospectively.
Peripheral blood stem cell transplant vs. regular BMT
What are the advantages and disadvantages for both donor and patient between peripheral stem cell and a regular bone marrow transplant?
In both procedures, doctors are collecting blood Cells in the body that develop into other cells. There are two main sources of stem cells. Embryonic stem cells come from human embryos and are used in medical research. Adult stem cells in the body repair and maintain the organ or tissue in which they are found. Blood-forming (hemapoietic) stem cells are found in the bone marrow. These cells make copies of themselves and develop into red cells, white cells, and platelets.
stem cells from the donor and transplanting them into the patient. The difference is the source of stem cells.
If a patient is having a bone marrow transplant, the donor is put under general anesthesia and a large needle is inserted in the hip bone. The soft, spongy tissue inside most bones. Blood cells are formed in the bone marrow.
Bone marrow, which contains blood stem cells, is withdrawn with a syringe. The donor experiences soreness in the hip area, and may experience discomfort up to 2 weeks.
If a person is donating peripheral blood stem cells, general anesthesia and overnight hospital stay are avoided. The donor must first take injections of a drug called Filgrastim (A man-made version of a naturally occurring substance in the body that promotes white blood cell growth in the bone marrow. It is known as a hematopoietic growth factor or colony stimulating factorand is given by injection under the skin (subcutaneous) or in the vein (intravenous). Filgrastim is approved by the U.S. Food and Drug Administration (FDA) for use in cancer patients who are at risk of developing infection due to cancer treatment. It is also approved for treating other patients who have a very low white blood cell count. It is in a class of drugs called growth factors (cytokines).
G-CSF) over a four to five day period. Filgrastim causes the stem cells in the bone marrow to move into the blood stream where they can be collected. Filgrastim is usually tolerated well, though some donors experience side effects. Side effects usually resolve a few days after injections of filgrastim are stopped. Stem cell collection is a relatively painless procedure. Stem cells are collected from the donor's blood stream by inserting a needle into one arm vein.
In general, patients transplanted with stem cells collected from the bloodstream engraft slightly more rapidly than those transplanted with bone marrow. Some studies have found a slight increase in the risk of developing graft-versus-host disease for patients transplanted with peripheral blood stem cells, but it is not absolutely clear that this is the case.
Statistics on "mini-transplants"
Are there any statistics on the success rate of mini-transplants on MDS patients?
Mini-transplants, also called non-myeloablative transplants, use a less toxic pre-treatment regimen (chemotherapy) than is used for standard bone marrow transplants. This method of transplantation is considered investigational; there are not sufficient numbers of reported cases to give a firm answer to this question. The conservative approach is to reserve mini-transplants for patients who are not eligible for full transplants (because of older age, the lack of an appropriately matched donor, or other reasons).
Platelet counts after BMT
Is it unusual for platelet levels to vary from 100,000 to 150,000 range six months after transplant for aplastic anemia?
That The smallest type of blood cell. Platelets help the blood to clot and stop bleeding. Also called a thrombocyte.
platelet level is below the normal level (150-450,000). In some patients there is slow improvement while in others the low level persists. Regardless, you should be able to participate in all normal activities with platelet counts in the 100,000-150,000 range.
ANC response after transplantation
How long does it take for a 14 year old aplastic anemia patient, who received marrow from a younger matched sibling donor, to show high (over 500) ANC counts?
In most cases this average is 14-21 days, but there is a wide range.
