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23 - Hematopoietic stem cell transplantation

from Part III - Evaluation and treatment

Published online by Cambridge University Press:  01 July 2010

By
Rupert Handgretinger ,
Victoria Turner  and
Raymond Barfield
Edited by
Ching-Hon Pui
Rupert Handgretinger
Affiliation:
Director Bone Marrow Transplantation, Department of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
Victoria Turner
Affiliation:
Director, HLA Laboratory, Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
Raymond Barfield
Affiliation:
Assistant Member, Department of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
Ching-Hon Pui
Affiliation:
St. Jude Children's Research Hospital, Memphis
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Summary

Introduction

Hematopoietic stem cell transplantation (HSCT) in children was first performed in March 1969 in a child with leukemia, who received cells from a sibling donor. By 1975, HSCT was being used successfully to cure otherwise incurable leukemias in adults. The next two decades produced remarkable advances in our understanding of histocompatibility and brought the development of novel immunosuppressive drugs. With the establishment of international bone marrow donor registries, HSCT has become a thera-peutic option for an increasing number of patients with otherwise incurable leukemias. With the addition of unrelated cord blood transplantation and the possibility of including partially mismatched or three loci-mismatched haploidentical family members in the donor pool, a stem cell donor can now be identified for almost every patient with leukemia for whom allogeneic transplantation is considered to be superior to conventional chemotherapy. This chapter reviews practical aspects of HSCT, its application to children and young adults with leukemia, the acute and late toxicities associated with transplantation, and approaches to exploiting the antileukemic effect of allogeneic transplants while minimizing the short and long-term side effects in children with leukemia.

Donor selection for HSCT

The selection of donors for HSCT depends upon the match between the prospective donor and the recipient in terms of the products of a group of genes on chromosome 6, the so-called major histocompatibility complex (MHC). The products of the MHC tested for histocompatibility purposes are referred to as HLAs or human leukocyte antigens.

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Type
Chapter
Information
Childhood Leukemias , pp. 599 - 624
Publisher: Cambridge University Press
Print publication year: 2006

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  • Hematopoietic stem cell transplantation
    • By Rupert Handgretinger, Director Bone Marrow Transplantation, Department of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA, Victoria Turner, Director, HLA Laboratory, Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA, Raymond Barfield, Assistant Member, Department of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
  • Edited by Ching-Hon Pui
  • Book: Childhood Leukemias
  • Online publication: 01 July 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511471001.024
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  • Hematopoietic stem cell transplantation
    • By Rupert Handgretinger, Director Bone Marrow Transplantation, Department of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA, Victoria Turner, Director, HLA Laboratory, Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA, Raymond Barfield, Assistant Member, Department of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
  • Edited by Ching-Hon Pui
  • Book: Childhood Leukemias
  • Online publication: 01 July 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511471001.024
Available formats
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Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Hematopoietic stem cell transplantation
    • By Rupert Handgretinger, Director Bone Marrow Transplantation, Department of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA, Victoria Turner, Director, HLA Laboratory, Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA, Raymond Barfield, Assistant Member, Department of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
  • Edited by Ching-Hon Pui
  • Book: Childhood Leukemias
  • Online publication: 01 July 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511471001.024
Available formats
×