Haemopoietic stem cell transplantation (types, indications, complications)
1. Big picture
Haemopoietic stem cell transplantation (HSCT) means giving haematopoietic stem cells to restore bone marrow function after myeloablative or immunosuppressive treatment, or to replace a diseased marrow/immune system.
The oral exam core:
Autologous HSCT = patient’s own stem cells → high-dose chemotherapy rescue.
Allogeneic HSCT = donor stem cells → new immune system + graft-versus-leukemia effect, but risk of GVHD.
The key distinction is:
| Type | Main purpose | Main advantage | Main danger |
|---|---|---|---|
| Autologous | Allow very high-dose chemotherapy | Lower transplant mortality; no classical GVHD | Relapse; no graft-versus-leukemia effect |
| Allogeneic | Replace diseased marrow with donor marrow/immune system | Curative graft-versus-leukemia/lymphoma effect | Graft-versus-host disease, infections, transplant mortality |
The textbook emphasizes that allogeneic HSCT creates a chimeric state, where marrow-derived cells come from the donor while other somatic tissues remain recipient-derived; it also highlights the close relationship between graft-versus-host disease (GVHD) and the beneficial graft-versus-leukemia (GVL) effect.
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