Blood stem cell allografting.
The emergence of peripheral blood stem cells as the preferred source of autologous rescue in high-dose therapy has indicated their potential benefits for allogeneic transplantation. Adequate mobilization with minimal side-effects can be achieved in normal donors using a short course of G-CSF. Allogeneic stem cells provide long-term engraftment that appears to be more rapid than that seen with marrow, but this observation awaits confirmation in a prospective randomized study. The cellular composition of stem cell and bone marrow allografts is very different, with greater numbers of CD34+ progenitors, T lymphocytes, and natural killer cells in stem cell harvests. Although infused T-cell numbers are increased, no difference in acute graft-versus-host disease has been documented between stem cell and marrow allografts. Any differences in chronic graft-versus-host disease or relapse risk await longer follow-up. It is likely that the use of allogeneic stem cells will expand both in matched sibling and mismatched transplantation.
Haynes
A P
AP
Nottingham City Hospital, Department of Haematology, UK.
Russell
N H
NH
D006086:Graft vs Host Disease; D019650:Hematopoietic Stem Cell Mobilization; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D014184:Transplantation, Homologous