Hey, I’m Bhagirathbhai Dholaria, Assistant Professor in Hematology,/Oncology and Stem Cell Transplant in Vanderbilt University Medical Center in Nashville, Tennessee. Today I’ll be talking about bloodless autologous stem cell transplantation. Although many of you may have heard about this, but not been commonly utilized. And it’s a very important procedure because it’s key for any individual who’s suffering from hematological malignancy who otherwise required autologous transplant, but prefers not to take any blood product...
Hey, I’m Bhagirathbhai Dholaria, Assistant Professor in Hematology,/Oncology and Stem Cell Transplant in Vanderbilt University Medical Center in Nashville, Tennessee. Today I’ll be talking about bloodless autologous stem cell transplantation. Although many of you may have heard about this, but not been commonly utilized. And it’s a very important procedure because it’s key for any individual who’s suffering from hematological malignancy who otherwise required autologous transplant, but prefers not to take any blood product.
Jehovah’s Witness is a large group of patients who does not accept any type of blood product, and there are over 8.8 million Jehovah’s Witness worldwide, so there is definitely an urgent need to develop a safe transplant strategies for these individuals, because in many cases, such as relapsed lymphoma, autologous transplant is a curative therapy, as we know. And these patients are currently getting suboptimal therapy if they don’t receive a stem cell transplant when it is indicated appropriately.
So, the original, one of the best studies in this field was published by Professor Ford, from U Penn who pretty much pioneered this approach of optimizing the patients hematological parameters before stem cell transplant, minimizing the [inaudible] blood loss, and also pre-emptively controlling any bleeding episodes to kind of safely take the patients with Jehovah’s Witness or anybody who otherwise choose not to accept any blood product during autologous stem cell transplantation.
And their experience has been published now in 2015 in JCO as a really nice series of 125 patients. The study showed that the hundred-day non-relapsed mortality was only 4.8%. There were a third of the patient who experienced some cardiovascular event, including seven and a half percent who died from this, but there were no bleeding related death in their case series.
Subsequently other centers have published their own experience such as Cedars-Sinai group, when they actually compared the outcome of around 66 patients who underwent bloodless autologous stem cell transplantation with standard of care autologous transplant with blood product support. And the study basically showed that the TRM at three months was only 2.9% and overall survival is no different in long term. There was one patient who died from intracranial hemorrhage, but they had active CNS malignancy jump cell metastases at the time of conditioning. So, studies have shown that this approach is relatively safe and can lead to good results if appropriate precautions and steps are taken.
