Autologous stem cell transplantation

Involves the transplantation of the patient’s own bone marrow or peripheral blood stem cells.

Mortality only 1-2% in appropriately selected patients.

Myeloma most common indication for ASCT in North America.

Most commonly used in the treatment of lymphoma and myeloma, with 30,000 autologous stem cell transplants performed worldwide 2009.

ASCT requires collection and cryopreservation of autologous peripheral blood stem cells (PBSCs),

PBSCs are mobilized from the bone marrow into the bloodstream using chemotherapy and hematopoetic factors such as filgrastim or granulocytes macrophage-colony-stimulating factor or growth factors alone.

PBSCs are collected by apheresis and cryopreserved for reinfusion at a later date.

Before reinfusion of peripheral blood stem cells, patients undergo conditioning with high-dose radiation and or chemotherapy.

PBSCs are cryopreserved with DMSO with or without hydroxyethyl starch.

As a result of cryopreservation PBSCs can be frozen for an extended period of time, although maximum duration is not in place.

In patients with chronic ischemic heat failure, transendocardial injection of autologous bone marrow mononuclear cells does not improve left ventricular end systolic volume, maximal oxygen consumption or reversibility on single photon emission tomography (FOCUS-CCTRN Trial).

Hematopoietic stem cell mobilization fails in approximately 20% of patients with myeloma in up to 40% of patients with non-Hodgkin’s lymphoma.

Poor mobilization leads to poor engraftment, and increased morbidity.

Causes of poor mobilization include age, underlying disease process, prior therapy, underlying bone marrow function.

Poor mobilization of hematopoietic stem cells cannot be predicted.

Recombinant herpes zoster vaccine is effective in reducing the incidence of herpes zoster in patients undergoing autologous stem cell transplant.

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