Transplant

Hematopoietic stem cell transplantation (HSCT) is the transplantation of multipotent hematopoietic stem cells, usually derived from bone marrow, peripheral blood, or umbilical cord blood. It is a medical procedure in the fields of hematology and oncology, most often performed for patients with certain cancers of the blood or bone marrow, such as multiple myeloma or leukemia. In these cases, the recipient's immune system is usually destroyed with radiation or chemotherapy before the transplantation. Infection and graft-versus-host disease is a major complication of allogenic HSCT.
Hematopoietic stem cell transplantation remains a dangerous procedure with many possible complications; it is reserved for patients with life-threatening diseases. As the survival of the procedure increases, its use has expanded beyond cancer, such as autoimmune diseases.^{[1][2] wikipedia
==================================================================}

Around the World over 50,000 Bone marrow transplants occur now each year.  Bringing cure to many lives.  When it is allogeneic, the graft-versus tumor effect prolongs the cancer killing...yielding better cure rates, sometime at the risk of graft versus host disease that requires careful management.  In most leukemia, Allogeneic transplant is the only curative option (CML).  Transplant can also restore immuno-deficiency in congenital syndromes such as the Wiskott-Aldrich Syndrome and the severe combined deficiency-immunodeficiency syndrome.
When the risk is reasonable, transplant has been indicated to:
1.Restore defectuous Red Blood Cells (Aplastic Anemias, Thalassemias,
2.Restore deficient enzymatic and metabolic diseases (Gaucher disease)
3.fight malignancies by allowing to use high doses of both Radiation and chemotherapy when Marrow rescue is assured.

Bone marrow Transplantation leads to 5 year survival of 50 to 70% when used in first remission of AML, and ALL.  This result is better than the best conventional chemotherapy.  It is therefore standard of care in the United States.  In Non Hodgkin Lymphoma, transplantation is most indicated when there is evidence of Marrow involvement.

Autologous transplantation is primarily used with Myeloma in the United States, although it is also used in
1.Non Hodgkin lymphoma and in recurrent germ cell cancers (Testicular) and in Neuroblastoma,
2.Myeloma.
3. but also AML and ALL.

Depletion of T cell in the marrow is used decrease graft-Vesus Host effect in allogeneic BM transplantation, while the use of Automated direct sequencing allow the discovery of more secondary HLA mismatch which improves unrelated donor selection.

Tumor contamination and lack of GVHD makes autologous transplant less effective.  Researchers are looking to better detect contamination and may be develop eradication methods to improve results of Autologous transplant!

Relapse after transplant can respond to
1.Cessation of immuno-suppressant if it was on them in Hematologic cancers
2.Reinfusionn of donor lymphocytes (often after reinduction chemotherapy)
3.Reduce-intensity allogeneic retreatment
4.or 2nd full transplant if the progression free survival was over a year
5.some new target therapy!

GVHD, Veno-Occlusive Hepatic disease and infections plague transplantation, particularly the allogeneic type, makes this procedure risky !  (read also Frederic Appelbaum)

(The CRBCM is in the process of acquiring a PCR  light Cycler...research will advance at CRBCM)