Feature Summary

To improve the outcome of patients with hematological malignancies and some solid tumors, including those with high risks of relapse or those relapsed patients.

To rescue the outcome of patients with marrow failure.

Overview

Hematological malignancies, solid tumors and marrow failure

Patients with hematological malignancies including non-Hodgkin lymphoma, Hodgkin lymphoma, acute myeloid and lymphoid leukemia, and myelodysplastic syndrome; and marrow failure (e.g. severe aplastic anemia) may need high dose therapy followed by autologous or allogeneic hematopoietic stem cell transplantation to control and even cure their diseases. In addition, patients with some solid tumors including brain tumors and germ cell tumor may need high-dose therapy followed by autologous hematopoietic stem cell transplantation to rescue their diseases.

Features

Since 1984, hematopoietic stem cell transplantation has been used to treat patients at Taipei Veterans General Hospital (Taipei VGH) and more than 1600 patients have undergone the procedure. In addition to autologous setting, allogeneic grafts are mainly gifted from family members and unrelated donors, including human leukocyte antigen (HLA) – matched and mismatched (e.g. haploidentical). The types of hematopoietic stem cells included bone marrow, peripheral blood stem cells and cord blood.

Procedure

Pre-transplant evaluations include patient’s disease (previous treatments and disease status) and comorbidities including cardiac and pulmonary function tests, the amount and storage condition of hematopoietic stem cells in the autologous setting, the availability and HLA matching status of allogeneic transplant donors, and the choice of preparative (conditioning) regimen (reduced intensity or myeloablative) and hematopoietic stem cell types. Except for patients with immunodeficiency, patients should receive preparative or conditioning therapy (usually high dose chemotherapy and/or total body irradiation) before transplantation, medications for prophylaxis of acute graft-versus-host-disease (GvHD) during the peri-transplant period of allogeneic transplantation. The infusion of hematopoietic stem cells is usually performed in laminar air flow rooms. After transplantation, patients receive transfusion support and supportive care including the use of granulocyte-colony stimulating factor (G-CSF), antibiotics, and peripheral parenteral nutrition.

Notification

Risks & complications

• Early complications: within the first 30–60 days after hematopoietic stem cell transplantation a.
• Hemorrhagic cystitis
• Endothelial injury:
• venoocclusive disease of the liver
• capillary leakage syndrome
• engraftment syndrome;
• diffuse alveolar hemorrhage
• hematopoietic stem cell transplantation-associated thrombotic microangiopathy
• Idiopathic pneumonia syndrome
• Infections
• Bacterial infection
• fungal infection
• viral infection
• Graft-versus-host-disease (GvHD)
• Acute GvHD
• Chronic GvHD
• Late effects including fertility and gonadal dysfunction