Huamei School
The Benefits of Hematopoietic Stem Cell Transplantation(HSCT) Treatment
Casey Wu
SBI3U
Dave
2021.10.19
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At any given moment, there are trillions of cells pass through the blood vessels, one
cell can cycle through human's body in a minute. All of these cells come from deep
inside the bones of the body. In our perception, bones are very hard, but actually the
internal structure of bones is very dense with small holes. Blood vessels, large and
small, enter the body through these pores. Most of the larger bones in the body are
hollow inside, filled with soft marrow[1;The soft marrow and tissue inside the large
bone. As shown in figure].
Bone marrow is made up of fat and other supporting tissue, but its most basic element
is blood stem cells. These stem cells are constantly dividing, and they can
differentiate into many cell types, such as red blood cells, white blood cells and
platelets. Blood stem cells pump hundreds of billions of new red blood cells into
blood vessels every day. These new cells enter the bloodstream through capillaries in
the bone marrow. Through capillaries, they can reach larger blood vessels and exit the
bone. Once the blood of the person appears disease, very large probability is
concerned with bone marrow. Cancer usually begins with mutations in stem cells that
are not cancerous on their own, but these mutations can affect the process of
differentiation and produce malignant blood cells. Therefore, allogeneic bone marrow
transplantation is the most effective and desirable treatment for patients with
advanced cancer such as leukemia and lymphoma. Allogeneic bone marrow
transplantation involves replacing a patient's bone marrow with healthy bone marrow
from a donor.
Allogeneic bone marrow transplants first harvest hematopoietic stem cells from the
donor's bone marrow. Most commonly, the donor is circulated through a machine,
which separates the blood stem cells from the components. Alternatively, bone
marrow is extracted directly from the iliac crest, a bone in the donor's hip, with a
syringe. In the meantime, the person being treated prepares for surgery, which
involves high doses of chemotherapy or radiation to kill all the bone marrow in the
body. This destroys malignant cells and blood stem cells, which also weakens the
patient's immune system and makes it less likely that the patient's immune system will
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attack the transplanted cells. Next, the donated stem cells are injected into the
recipient through a central vein. These foreign cells circulate in the recipient's
peripheral blood. Stem cells, molecules called chemokine, act as homing cells, and
they guide their rapid migration to the bone marrow. Within a few weeks, they were
working normally. Stem cells divide, multiply, and start producing new, healthy blood
cells. All it takes is a few hematopoietic stem cells to give your whole body the
healthy bone marrow it needs again. Bone marrow transplants also have a
"graft-anti-tumor" effect, in which the transplanted bone marrow produces new
immune cells that can destroy cancer cells that the recipient's original immune cells
cannot. This effect eradicates many malignant diseases, so bone marrow
transplantation is the only treatment for many diseases.
At present, bone marrow transplantation is expensive, risky and has sequelae due to
individual differences. However, Its achievements in the field of medicine have
outweighed its disadvantages.
Hematopoietic stem cell transplantation (HSCT) continues to be widely used
worldwide. At the same time, with the continuous progress of transplantation
technology, the indications for HSCT have been further expanded. In addition,
relative haploid compatible donors have become an important source of hematopoietic
stem cells for patients who need allogeneic hematopoietic stem cell transplantation
(ALLO-HSCT) from sibling donors who do not possess HLA antigens.
1.Development trend of hematopoietic stem cell transplantation in the world.
The reference from (Advances in hematopoietic stem cell transplantation for
hematological disease)
Yu Wang and Xiaojun Huang
2019.Aug
According to the latest data published by the International Bone Marrow Transplant
Registry (IBMTR), the number of ALLO-HSCT cases in the US has been increasing
year by year, with more than 8,000 cases in 2013 and 8,539 cases in 2016. Similarly,
according to the Data of the European Bone Marrow Transplant Registry (EBMT),
the number of ALLO-HSCT cases in Europe exceeded 15 000 in 2013 and 16 507 in
2016. Data from the Chinese Bone Marrow Transplant Registry group (CBMTR)
showed that 102 hospitals registered in 2017, completing a total of 8,186 HSCT cases,
including 1,576 auto-HSCT cases (19%) and 6,601 ALLO-HSCT cases (81%).
The number of cases treated with HSCT worldwide has increased year by year due
to the decline in transplant-related non-recurrence mortality (NRM) as transplantation
technology has matured. In recent 10 years, the proportion of patients with advanced
age, high risk and high transplant comorbidities has been increasing. Data show that
the NRM of such patients 5 years after transplantation has decreased from 37% in
1980s and 39% in 1990s to 23% in recent 10 years (P=0.007). Continuous reduced
non-relapse mortality after allogeneic hematopoietic stem cell transplantation: a
single-institution's three decade experience.
It is worth mentioning that the rapid development of haplotype transplantation around
the world has ushered in the era of "donor for everyone", and autologous stem cell
donation itself is not much more complicated than blood donation. In ALLo-HSCT,
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from the perspective of donor-recipient relationship, IBMTR data show that the
proportion of related HLA incompatible transplants in the United States has exceeded
that of umbilical cord blood stem cell transplantation since 2013, and reached 1,500
cases (11%) in 2016, exceeding the more than 500 cases of umbilical cord blood stem
cell transplantation at that time. EBMT data show that since 2013, the proportion of
patients receiving related-HLA incompatible transplants in Europe has exceeded that
of umbilical cord blood stem cell transplants, reaching more than 2,000 in 2016,
surpassing that of umbilical cord blood stem cell transplants by more than 400.
CBMTR data showed that since 2013, the number of incompatible transplants of kin
HLA exceeded that of sibling HLA full matching transplants. Since 2016, the
proportion of genetic HLA incompatibility transplantation in ALLO-HSCT was more
than 50%. In ALLO-HSCT in 2017, 56% (3 723 cases) were transplanted with related
HLA incompatibility, 27% (1 803 cases) were transplanted with sibling HLA fully
matched, 12% (791 cases) were transplanted with non-related HLA, and 4% (284
cases) were transplanted with umbilical cord blood stem cells.These data all prove
that, with the development of transplantation technology and the maturity of
comorbidization treatment technology, and the fundamental problem of lack of donor
source being solved, HSCT, as a radical cure for a variety of blood diseases, is
increasing year by year in the global scope. Among the three large registries
mentioned above, acute myeloid leukemia (AML) was the first indication of
ALLo-HSCT. With the maturation of transplantation technology, the indications of
transplantation have been expanded from malignant blood diseases to non-malignant
blood diseases, and the transplantation of elderly patients with blood diseases has also
made great progress.
A) Effect of hematopoietic stem cell transplantation in elderly patients
Due to the development of reduced-intensity preconditioning transplantation
protocols and advances in comprehensive geriatric assessment, the proportion of
elderly patients choosing and undergoing stem cell transplantation is increasing year
by year. In 2016, patients over 60 years of age accounted for more than 50% of
auto-HSCT patients, and the proportion of patients younger than 70 years of age was
also increasing (12%), according to CIBMTR data. In ALLO-HSCT, patients older
than 60 years accounted for 30%, and patients younger than 70 years increased by
4.6%. Data from the Institute of Hematology at Peking University showed that there
was little difference in the efficacy of myeloablative transplantation in patients older
than 50 years of age. In recent years, the development of comprehensive geriatric
assessment and the update of transplantation comorbidities index provide a better
evaluation method for the application of HSCT in elderly patients, which is beneficial
for weighing the advantages and disadvantages and selecting transplantation plan.
B) Opportunities and challenges facing ALLO-HSCT in the next decade.
Relapse of leukemia is still one of the main causes of ALLO-HSCT failure.
CIBMTR data showed that recurrence accounted for 29% and 57% of deaths within
100 d and 100 d after non-sibling transplantation, respectively, and 23% and 46% of
deaths within 100 d and 100 d after non-sibling transplantation, respectively. In
addition to the traditional secondary transplantation and DLI, research hotspots in
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recent years have focused on the improvement of DLI, combined application with
new drugs and new cellular immunotherapy.
2. Benefit of bone marrow transplant in field of cancer
Statistics show that 9.5 million people died of cancer in 2018. Scientists predict that
by 2040, 16.4 million people will be suffering from cancer[2;An estimated 19.3
million new cases (18.1 million excluding Non-melanoma Skin Cancer(NMSC),
except basal cell carcinoma) and 10 million cancer deaths (9.9 million excluding
NMSC, except basal cell carcinoma) worldwide in 2020].
This means that almost every family will have someone affected by cancer. In recent
years, stem cell research has made remarkable progress in medicine, and stem cell
therapy is the most promising treatment for cancer and other diseases. Parkinson's
disease, for example, brings suffering and pain to many people that stem cells could
reduce or even eliminate. In the field of medicine, the control of drug ingredients is
very strict. The wrong ingredients can have devastating consequences. Therefore, to
ensure safety, its safety and clinical performance must be tested in other organisms
other than living people. The advantage of stem cells is that they are derived from
human cells, which can show exactly what a drug will do in the body. For example,
when testing the effects of a drug on the nervous system, scientists can coax stem
cells into differentiating into neural tissue to see how the drug affects that type of cell.
Stem cells provide medicine with a versatile weapon in the fight against disease.
Drug treatments are already used for heart disease and other degenerative diseases,
but stem cell research offers a whole new way to treat patients with these diseases.
Stem cells enter a patient's damaged tissue and repair and replace it. In a study
published in the Lancet medical journal, researchers treated damaged hearts with an
infusion of stem cells. They injected each patient with cardiac stem cells from the
patient's own heart muscle, and after a year the scar tissue had shrunk by 50 percent.
Harvard Health explains the phenomenon in an article: "Once in place, stem cells help
regenerate damaged heart tissue."
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The promise that stem cells hold for the field of regenerative medicine is great and
should not be abandoned. It could be the next big medical advance, with huge
potential for treating degenerative diseases.
It is well known that the deadliest disease is cancer. Today, it is common for cancer
patients to receive long-term chemotherapy to fight cancer, although chemotherapy
and radiation can keep patients alive and in some cases cure the cancer completely.
But for too many people, that doesn't happen. Currently, stem cell therapies are used
for specific types of cancer such as leukemia, lymphoma, neuroblastoma and multiple
myeloma, and hold promise for other types of cancer.
3. Bone marrow transplants are less harmful than long-term chemotherapy
While chemotherapy destroys cancer cells, it also damages healthy cells in the body,
leading to many side effects during chemotherapy. Side effects vary depending on the
concentration and type of chemotherapy drug used and the individual's physical
condition. Most of these side effects are temporary and can be treated or managed.
Hair loss is the most common side effect of chemotherapy and has the greatest
impact on people's mental health. There is limited research on the psychological
aspects of hair loss. Evidence shows that when a person is experiencing hair loss it is
harmful for mental health, which often creates strong negative emotions that lead to
personal, social and work problems. Hair loss can alter a person's appearance,
especially when eyelashes and eyebrows are affected while shaping a person's face.
Hair loss may be seen as an appearance that does not conform to social norms.
Compared with the general population, patients who suffer from hair loss have higher
rates of psychiatric disorders, including major depressive episodes, anxiety disorders,
social phobia or paranoia. This will be detrimental to the recovery of the disease.
Of course, a high dose of chemotherapy is necessary before a bone marrow
transplant. But after a successful bone marrow transplant, healthy stem cells in the
body later replace those in the mutated bone marrow, allowing the disease-ravaged
body to regenerate.
In conclusion, the benefits of bone marrow transplantation (stem cell transplantation)
outweigh some of its remaining disadvantages, such as its high price and high risk.
But with the development of technology, bone marrow transplantation technology
will continue to mature and widespread. Today, even elderly patients can undergo
bone marrow transplants to cure incurable diseases with the help of pretreatment tests
for complications.
The versatile stem cells are actually inside the human body. Stem cell research has
many benefits, and the medical power of stem cells should not be ignored or
abandoned.
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“Chemotherapy Side Effects & What to Expect | Icon Singapore.” Icon Cancer Centre
Singapore, iconcancercentre.sg/zh-hans/chemotherapy-side-effects/. Accessed 15 Nov.
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“Psychological Effects of Hair Loss | DermNet NZ.” Dermnetnz.org,
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