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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Explain the rationale for using hematopoietic stem cell transplant (HSCT) to treat cancer.

  2. Compare the different types of HSCTs, specifically (a) the types of donors (i.e., autologous and allogeneic), (b) the source of hematopoietic cells (i.e., umbilical cord, peripheral blood progenitor cells [PBPCs], and bone marrow), and (c) the type of preparative regimen (i.e., myeloablative and nonmyeloablative).

  3. List the nonhematologic toxicity to high-dose chemotherapy used in myeloablative preparative regimens, specifically busulfan-induced seizures, hemorrhagic cystitis, GI toxicities, and sinusoidal obstruction syndrome.

  4. Develop a plan for monitoring and managing engraftment of hematopoiesis.

  5. Explain graft-versus-host disease (GVHD).

  6. Recommend a prophylactic and treatment regimen for GVHD.

  7. Choose an appropriate regimen to minimize the risk of infectious complications in HSCT patients.

  8. Evaluate the long-term health care of HSCT survivors.

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KEY CONCEPTS

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  • Image not available. Hematopoietic stem cell transplantation (HSCT) is a procedure used mainly to treat hematologic malignancies via high-dose chemotherapy and/or a graft-versus-tumor effect.

  • Image not available. An autologous HSCT involves the infusion of a patient's own hematopoietic cells and allows for the administration of higher doses of chemotherapy, radiation, or both to treat the malignancy. Infusion of another's hematopoietic cells is an allogeneic HSCT; these cells can be from donors related or unrelated to the recipient.

  • Image not available. Umbilical cord blood, peripheral blood progenitor cells (PBPCs), and bone marrow can serve as the source of hematopoietic cells. The optimal cell source differs based on the donor and recipient characteristics.

  • Image not available. A myeloablative preparative regimen involves the administration of sublethal doses of chemotherapy to the recipient to eradicate residual malignant disease. The recipient will not regain his or her own hematopoiesis and will be at risk for substantial life-threatening nonhematologic toxicity.

  • Image not available. A nonmyeloablative preparative regimen is less toxic than a myeloablative regimen in hopes of being able to offer the benefits of an allogeneic HSCT to more patients. A nonmyeloablative HSCT is based on the concept of donor immune response having a graft-versus-tumor effect.

  • Image not available. Nonhematologic toxicity differs based on the preparative regimen administered.

  • Image not available. Engraftment is the reestablishment of functional hematopoiesis. It is commonly defined as the point at which a patient can maintain a sustained absolute neutrophil count (ANC) of greater than 500 cells/mm3 (0.5 × 109/L) and a sustained platelet count of greater 20,000/mm3 (20 × 109/L) lasting for 3 or more consecutive days without transfusions.

  • Image not available. Graft-versus-host disease (GVHD) is caused by the activation of donor lymphocytes, leading to immune damage to the skin, gut, and liver in the recipient. An immunosuppressive regimen is administered to prevent GVHD in recipients of an allogeneic graft; this regimen is based on the type of preparative regimen and the source of the graft.

  • Image not available. Recipients of HSCT are at higher risk of bacterial, viral, and fungal infections and usually receive a prophylactic or preemptive regimen to minimize the morbidity and mortality owing to infectious complications.

  • Image not available. Long-term survivors of HSCT should be ...

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