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Bone Marrow Transplants

Bone Marrow Transplantation in Brief

Almost six decades after the seminal work by E. Donnall Thomas et al, hematopoietic stem cell transplantation (HSCT) has become an accepted treatment option for defined hematological and non-hematological disorders. From 2006 to 2008, a total of 146,808 patients received HSCT worldwide1 a trend that continues to grow in both annual treatments and well as in breadth of applications benefiting from the technology. Peripheral blood stem cells (PBSC) have become the source of choice for HSCT2, however, bone-marrow has remained a preferred choice for specific high risk cases of HSCT, especially for non-malignant disorders (aplastic anemia, sickle cell anemia and thalassemia).3-6 Although, HSCT with PBSC leads to faster engraftment rates than bone-marrow (BM) and is relatively easier to process (via standard apheresis), development of chronic graft-vs-host disease (GVHD) presents a major limitation to its application.7-10  As technologies which optimize rapid and efficient processing of bone marrow become readily available, it’s clear that bone marrow will find increased usage as a cell source due to relative clinical advantages as seen in Table 1. below.

Table 1: Peripheral blood stem cells (PBSC) compared to unstimulated bone-marrow (BM) stem cells in HSCT. N: neutrophils, P: platelets.

PBSC

BM

Survival rates

Similar

Similar

Engraftment rates (Median time)

15 days (N) and  18 days (P)

20 days (N) and  27 days (P)

Graft failure

Low incidence

Higher Incidence

Acute GVHD

Similar

Similar

Chronic GVHD

High Incidence

Lower incidence (compared to PB)

Death, results of

Chronic GVHD

Higher graft failure

 

 

 

 

 

 

 

 

 

 References:

  1. Gratwohl et al., (2013) Quantitative and qualitative differences in use and trends of hematopoietic stem cell transplantation: a global observational study, Haematologica, (doi:10.3324/haematol.2012.07634)
  2. Mielcarek et al., (2012) Long-term outcomes after transplantation of HLA-identical related G-CSF–mobilized peripheral blood mononuclear cells versus bone marrow, Blood, 119, 2675-78
  3. Bacigalupo et al., (2012) Bone marrow versus peripheral blood as the stem cell source for sibling transplants in acquired aplastic anemia: survival advantage for bone marrow in all age groups, Haematologica, 97, 1142-48
  4. Matthes-Martin et at al., (2013) Stem cell transplantation after reduced-intensity conditioning for sickle cell disease, Eur. J. Haematol., 90, 308-12
  5. Claudio Anasetti, M et al., (2012), Peripheral-Blood Stem Cells versus Bone Marrow from Unrelated Donors, New Engl Journal of Medicine, 367;16, 1487-1496.
  6. Andrea Bacigalupo et al., (2012), Bone marrow versus peripheral blood as the stem cell source for sibling transplants in acquired aplastic anemia: survival advantage for bone marrow in all age groups, Haematologica,2012;97(8):1142-1148.
  7. William I. Bensinger, (2012), Allogeneic Transplantation: Peripheral Blood versus Bone Marrow. Curr Opin Oncol. 2012; 24(2): 191–196.
  8. Roland Meisel, et al., (2013), Peripheral blood stem cells versus bone marrow in pediatric unrelated donor stem cell Transplantation. Blood, 121: 863-865
  9. Kimura F et al. (2008) Impact of ABO-blood group incompatibility on the outcome of recipients of bone marrow transplants from unrelated donors in the Japan Marrow Donor Program. Haematologica 2008; 93:1686-1693.
  10. Dinsmore et al. (1983) ABO incompatible bone marrow transplantation: removal of erythrocytes by starch sedimentation. Br J Haematol 1983; 54: 441–449.