History of stem cell and bone marrow transplantation in cancer and leukemia – pro

M Levin, MD — Sat, 01 Sep 2012 02:24:00 +0000

The history of stem cell research includes work with both animal and human stem cells. Stem cells can be classified into three broad categories, based on their ability to differentiate. Totipotent stem cells are found only in early embryos. Each cell can form a complete organism (e.g., identical twins). Pluripotent stem cells exist in the undifferentiated inner cell mass of the blastocyst and can form any of the over 200 different cell types found in the body. Multipotent stem cells are derived from fetal tissue, cord blood, and adult stem cells.

A prominent application of stem cell research has been bone marrow transplants using adult stem cells. Among early attempts to do this were several transplants carried out in France following a radiation accident in the late 1950′s. Since physicans could not isolate stem cells at that time, they transfused bone marrow with stem cells in it. Autologous marrow means from the same individual while allogeneic marrow is provided by another individual. A bone marrow transplant between identical twins guarantees complete HLA compatibility between donor and recipient. These were the first kinds of transplants in humans, followed by autologous transplants. It was not until the 1960′s that physicians knew enough about HLA compatibility to perform transplants between siblings who were not identical twins. In 1973 a team of physicians performed the first unrelated bone marrow transplant. In 1984 Congress passed the National Organ Transplant Act, which among other things, included language to evaluate unrelated marrow transplantation and the feasibility of establishing a national donor registry. This led ultimately to National Marrow Donor Program (NDWP) a separate non-profit organization that took over the administration of the database needed for donors in 1990. The 1990′s saw rapid expansion and success of the bone marrow program with more than 16,000 transplants to date for the treatment of immunodeficiencies and leukemia.

Now that stem cells can be harvested from the blood, stem cell transpalntation has largely replaced bone marrow transplantation, although recent trials have revived an interest in bone marrow trnasplantation and its possible advantages over stem cell transplants. Adult stem cells also have shown great promise in other areas. Stem cell transplant for acute myelogenous leukemia. Philadelphia (PA): Intracorp; 2005. Various p. [50 references]

http://www.emedicine.com/med/topic3497.htm

Buckner CD: Autologous bone marrow transplants to hematopoietic stem cell support with peripheral blood stem cells: a historical perspective. J Hematother 1999 Jun; 8(3): 233-6

Autoimmune hemolytic anemia basics – pro

M Levin, MD — Mon, 27 Aug 2012 17:26:43 +0000

Lay Summary: I discuss some very basic facts about AIHA.

Autoimmune hemolytic anemia (AIHA) due to the presence of warm agglutinins is almost always due to IgG antibodies that react with protein antigens on the red blood cell (RBC) surface at body temperature. For this reason, they are called “warm agglutinins” even though they seldom directly agglutinate the RBCs. IV Gammaglobulin blocks this process.

I some cases, AIHA can be characterised by a chronic course and an unsatisfactory control of haemolysis, thus requiring prolonged immunosuppressive therapy. Sometimes when medical measures fail, it may be necessary to surgically remove the spleen (splenectomy). The clinical course of the disease may show either resistance to steroids or dependence on high-dose steroids with subsequent development of severe side effects on growth, bone mineralisation, and the endocrine system. Splenectomy is effective in about 50 to 60 percent of the time in IgG antibody diseases but is not usually effective in IgM antibody haemolysis. Splenectomy is of benefit in these people because the spleen behaves like a sieve and if it is removed, even though the RBCs are coated by antibodies, they are no longer caught and destroyed in the spleen.

IVIG is an accepted treatment for autoimmune hemolytic anemia. Unlike steroids, it does not induce remissions but is a temporizing measure until a definitve treatment can be planned and delivered. IVIG is not as effective in AIHA as it is in ITP. Other treatments can sometimes be used.

Autoimmune hemolytic anemia can be associated with lymphoproliferative conditions and lymphoma. A clinical examination (to rule out lymphadenopathy, splenomegaly) is obligatory. The need for additional investigations must be determined by history, clinical findings, and the type of antibody. Routine work-up relevant for treatment decisions may include abdominal examination by computed tomographic scan (to search for splenomegaly, abdominal lymphomas, ovarian dermoid cysts, renal cell carcinoma), quantitative determination of immunoglobulins, a search for a lupus anticoagulant in case of warm antibodies, or a bone marrow examination and a search for clonal immunoglobulins (immune fixation) in case of cold antibodies.

Ucar K. Clinical presentation and management of hemolytic anemias. Oncology [Huntingt] 2002;16(9 suppl 10):163-70.

Schwartz RS, Berkman EM, Silberstein LE. Autoimmune hemolytic anemias. In: Hoffman R, Benz EJ Jr, Shattil SJ, Furie B, Cohen HJ, Silberstein LE, et al., eds. Hematology: basic principles and practice. 3d ed. Philadelphia: Churchill Livingstone, 2000:624.

Klaus Lechner and Ulrich Jäger, How I treat autoimmune hemolytic anemias in adults. September 16, 2010; Blood: 116 (11)

So Yeon Park et al, A Case of Non-Hodgkin’s Lymphoma in Patient with Coombs’ Negative Hemolytic Anemia and Idiopathic Thrombocytopenic Purpura. Cancer Res Treat. 2012 Mar; 44(1): 69–72.

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History of stem cell and bone marrow transplantation in cancer and leukemia – pro

Autoimmune hemolytic anemia basics – pro