Transplantation of hematopoietic stem cells in

pediatric oncology

Vladivostok State Medical University

Foreign languages department

Vladivostok2012

Scientific advisor:Korotkova E.A.Performed by:

Batmanova N.A.

• The aim:

to summarize the indications for hematopoietic stem cells transplantation in children, to identify the main complications, and to demonstrate the results of the HSCT for various kinds of nosology, based on the

results of specialized bone marrow transplantation unit.

The basic contents:

Transplantation of hematopoietic stem cells – the introduction of the recipient suspension of hematopoietic stem cells (HSC) after the appointment of myeloablative radiation doses or maximally tolerated doses of cytotoxic agents;

Stem cells – a population of undifferentiated cells with the capacity to divide for indefinite periods, to self-renew and to generate a functional properties and functions.

Pic.1 Normal bone marrow cytology

The sources of stem cells: Bone marrow

- Traditional source of precursor cells;

- Requires intake in the operating room;

- Used mostly in allotransplantation.

Peripheral blood

- requires the mobilization of donor precursor cells with the aid of chemotherapy, hematopoietic growth factors, or both;

- used primarily in autotransplantation.

Cord blood

- taken from the umbilical cord after birth.

The main types of hematopoietic stem cell transplantation;

Autological transplantation

As a source of cells the patients own precursor cells are used;

Syngeneic transplantation

Possible when a potential recipient has an identical twin, who can become a stem cell of a precursors donor;

Allogeneic transplantation

When other donor is used for transplantation, who differ in histocompatibility.

The basic indications for allo-HSC transplantation: Acute lymphoblastic leukemia in second remission, in first

remission in case of relapse; Сhronic myeloid leukemia; Severe forms of BM insufficiency; Some hereditary blood diseases; Some non-hematological hereditary diseases; Immunodeficiency conditions.

The basic indications for allo-HSC transplantation: Acute lymphoblastic leukemia in second remission, in first

remission in case of relapse; Solid tumors (neuroblastoma, brain tumors, osteosarcoma,

Ewing's sarcoma, rhabdomyosarcoma, other tumors.

Absolute indications for allo-HSC are identical and considered individually applied for each patient!

Post-transplantation complications

Pict.2 Macular rush as an expression of GVHR

1. Acute reaction «graft-versus-

host» (GVHR) –

clinicopathologic syndrome,

including skin lesions, liver and

intestine.

Post-transplantation complications

Pic. 3

Macular rush on the soles as an expression of acute GVHR

Characterized by spotted red rush with itching and soreness;

Should be

differentiated with chemotherapy induced rush, drug allergy and viral exanthema.

Post-transplantation complications

2. Chronic reaction «graft-versus-host»

Clinical-pathological syndrome that

involves the skin, liver, eyes, oral cavity,

gastrointestinal tract, lung and

neuromuscular systems.

Pic. 4. Skin lesions in chronic GVHR

Post-transplantation complications

Pic. 5 Aseptical skin lesions in chronic GVHD

The event-free survival of patients with Ewing's sarcoma family of tumors

n=50, after 2000 year,

64%, 74 months.

Overall, among 104 patients at high risk group event-free survival were 64% at median follow-up 74 months.

n=24, before 2000 year,

8%, 24 monthes.

Event-free survival of patients with neuroblastoma of high risk group

17 patients of high risk group;

15 patients – stage IV of neuroblastoma;

Event-free survival 35% at median follow-up 37 months

Event-free survival of patients with relapses of nephroblastoma

Months after treatment

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29,4%Medium follow-up40 months

10 out of 34 patients (29,4%) are alive without evidence of the disease

Haploidentical bone marrow transplantation

20 patients

15 girls 5 boys Average age - 11 years

14 patients - 6 patients – solid

haemoblastosis tumors 21 haploidentical transplantation (1 patient was

transplanted twice)

Overall survival after haploidentical transplantation

35,6%

16%

Relapse-free survival

Event-free survival

Median follow-up 23 and 16 months

Conclusions:

Transplantation of hematopoietic stem cells is one of the most effective methods of treatment of various diseases of the blood system in children;

HSCT allowed to increase disease-free and event-free survival in patients with Ewing′s sarcoma, neuroblastoma, relapses of nephroblastoma and patients with hemoblastosis;

Infectious complications and acute graft-versus-host were the main complication and cause of death in patients after allogeneic HSCT. Correction of these conditions will improve remote results and life quality of patients after allogeneic HSCT;

The efficiency of method depends not only the relapse, but also on the stage of disease at the moment of transplantation.

Thank you for attention!