Bone Marrow and Stem Cell Transplant

Bone Marrow and Stem Cell Transplant is a topic covered in the 5-Minute Pediatric Consult.

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Basics

Description

  • Hematopoietic stem cell transplantation (HSCT) is the infusion of progenitor stem cells with the intention of restoring hematopoiesis and immunity. HSCT can be classified by
    • Donor type: syngeneic (derived from an identical twin), allogeneic (derived from a related or unrelated donor), or autologous (derived from the patient prior to stem cell-toxic therapy)
    • Product type
      • Bone marrow transplantation (BMT): Stem cells are obtained by harvesting bone marrow under anesthesia.
      • Peripheral blood stem cell transplantation (PBSCT): Stem cells are mobilized to the periphery with cytokines (GCSF) and collected by apheresis.
      • Umbilical cord blood transplantation (UCBT): Stem cells are collected from the umbilical cord and placenta immediately after birth.
  • Stem cells are infused in the peripheral blood of the recipient using a central venous catheter, similar to a blood transfusion. They then home to the bone marrow niche and over the next 2 to 4 weeks differentiate into mature blood components.

Epidemiology

  • In 2013, >1,900 pediatric allogeneic HSCTs were performed worldwide. Approximately 40% of allogeneic transplants are from matched related donors.
  • The use of unrelated PBSCT and unrelated UCBT has been gradually increasing since the late 1990s, whereas the use of related BMT has remained stable.

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