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MindMap Gallery Hematopoietic stem cell transplantation

Hematopoietic stem cell transplantation

This is a mind map about hematopoietic stem cell transplantation. The main contents include: hematopoietic stem cell transplantation and blood transfusion, hematopoietic stem cell collection and processing, overview.

Edited at 2024-01-31 17:21:11

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Hematopoietic stem cell transplantation

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Outline

Clinical transfusion laboratory quality management
- 42
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Adverse transfusion reactions and transfusion-transmitted diseases
- 46
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Autologous transfusion (AT)
- 26
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clinical blood transfusion
- 50
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Hematopoietic stem cell transplantation

Overview

Biological properties of HSC and the mechanism of HSCT in treating diseases

Hematopoietic stem cells (HSC)

A group of primitive hematopoietic cells present in hematopoietic tissue, with the ability of self-renewal and multi-directional differentiation

Hematopoietic stem cell transplantation (HSCT)

After the patient undergoes total body irradiation, chemotherapy, and immunosuppressant treatment, HSC isolated from the donor's bone marrow, peripheral blood, or umbilical cord blood is transfused to rebuild hematopoietic and immune functions.

HSCT process

High-dose chemotherapy or chemotherapy plus radiotherapy to remove tumor cells and allow implanted hematopoietic stem cells to survive

Enter HSC

Supportive care before HSC transplantation

Immunosuppressants to prevent graft-versus-host disease

HSC homing capability

Intravenous infusion of HSC can enter bone marrow proliferation and differentiation (homing), and intravenous infusion of HSC can achieve the purpose of transplantation.

HSCT classification

Whether the HSCs were obtained from the patient himself or from a healthy donor

1. Autologous hematopoietic stem cell transplantation

2. Allogeneic hematopoietic stem cell transplantation

a. Syngeneic hematopoietic stem cell transplantation

b. Allogeneic hematopoietic stem cell transplantation

By HSC source

a.Bone marrow transplantation

b. Peripheral blood hematopoietic stem cell transplantation

c. Umbilical cord blood hematopoietic stem cell transplantation

Whether there is a blood relationship between the donor and the recipient

blood transplant

unrelated transplant

According to human leukocyte antigen (HLA) compatibility

a.HLA-matched transplantation

b.HLA partially matched transplantation

c.Haploidentical transplantation

1. Autologous hematopoietic stem cell transplantation (auto-HSCT)

Use the patient's own HSC, collect and store them before transplantation (also known as "high-dose therapy rescue")

High-dose chemotherapy or radiotherapy can eliminate tumor cells to the maximum extent, shorten the time of pancytopenia after radiotherapy and chemotherapy, and reduce adverse reactions. However, autologous stem cells are often mixed with a small amount of tumor cells and are prone to recurrence after transplantation.

The purpose of auto-HSCT is to prolong the remission period rather than to cure it

Contraindications

a. Hereditary diseases, such as globin production disorder anemia (thalassemia)

b. Stem cell diseases, such as myelodysplastic syndrome and aplastic anemia

advantage

No need to find a donor

No GVHD

shortcoming

Stem cells may be mixed with tumor cells

Early chemotherapy can damage stem cells, resulting in insufficient stem cell numbers, resulting in abnormal bone marrow hyperplasia after transplantation.

No graft-versus-tumor effect

2. Syngeneic hematopoietic stem cell transplantation (syu-HSCT)

HSC originates from identical twins

The donor and recipient genes are completely identical, and no rejection or inhibitor-versus-host disease will occur.

Does not contain tumor cells and is superior to autologous transplantation

Suitable for acquired hematopoietic stem cell diseases, not suitable for genetic diseases

advantage

No GVHD

shortcoming

Difficulty finding a donor

No graft-versus-tumor effect

3. Allogeneic hematopoietic stem cell transplantation (allo-HSCT)

HSC source

HLA-matched related donor

The donor is a sibling of the recipient, and the HLA between donor and recipient is completely consistent.

HLA incompletely matched related donor

1, 2, or 3 HLA antigens between donor and recipient are incompatible

HLA-matched unrelated donor

Donor-recipient HLA antigens are completely or mostly identical, but not related by blood

HLA haplotype similarity

The HLA alleles at the three loci on one chromosome of the donor and the recipient are identical, but the HLA alleles on the other chromosome are different.

The success of the transplant depends on whether the major histocompatibility complex (MHC) is the same, that is, whether the human leukocyte antigen (HLA) is compatible

allo-HSCT failure reasons

Rejection

Differences in major or minor histocompatibility antigens between donor and recipient can cause rejection.

Disease type

Patients with aplastic anemia are more likely to develop the disease than patients with leukemia

immune factors

The dose of immunosuppressant before transplantation is too low

Do inhibitors remove T cells?

non-immune factors

Insufficient number of transplanted stem cells

The patient is too sick

Graft versus host disease (GVHD)

Is a complication of allogeneic hematopoietic stem cell transplantation

GVHD is T cell-mediated direct destruction of the recipient's target organ by donor cells or target organ damage induced by cytokines.

Donor-recipient HLA mismatch will increase the risk of GVHD. Removing transplant T cells can alleviate GVHD, but it will also weaken the graft-versus-leukemia (GVL) effect and increase the risk of relapse.

Removing T cells delays immune reconstitution and increases the risk of infection and post-transplant lymphoproliferative disease.

advantage

Have graft-versus-tumor effect

No tumor cell contamination in stem cells

Reduced dose conditioning regimens can be used to reduce toxic side effects

shortcoming

A suitable donor may not be found

GVHD

Rejection

Hematopoietic stem cell collection and processing

bone marrow hematopoietic stem cells

advantage

Rich in HSC

Contains fewer lymphocytes than peripheral blood stem cells

Less GVHD

shortcoming

Anesthesia is required during collection

Progenitor cell content is lower than in peripheral blood

Clinical application

It is a traditional source of HSC and has rich clinical experience.

Collection and processing of peripheral blood hematopoietic stem cells

advantage

Contains large amounts of HSC

Containing a large number of lymphocytes, the graft has a stronger anti-tumor effect

shortcoming

Donors require granulocyte colony-stimulating factor (G-CSF) for mobilization, which takes a long time

Clinical application

Mostly used for autologous HSCT

Allogeneic HSCT mostly used in reduced-dose conditioning regimens

cord blood stem cells

advantage

Collection poses no risk to mother or baby

Less likely to spread infectious diseases and easily acquired

Does not require complete HLA matching

Lymphocyte immune function is immature, and the incidence and severity of GVHD are low.

shortcoming

The number of stem cells is limited, and the number of stem cells is insufficient for overweight children and adults.

Takes longer to develop graft-versus-tumor effect

Clinical application

The first choice for unrelated donor transplantation in children

Short time from finding a donor to transplantation

Hematopoietic stem cell transplantation and blood transfusion

HSCT patients will experience pancytopenia lasting approximately 2 weeks or longer before hematopoietic reconstitution.

Clinical application

anemia

transfusion of irradiated red blood cells

agranulocytosis

Instead of infusing granulocytes, G-CSF or GM-CSF can be used to accelerate the recovery of bone marrow granulocytes.

Thrombocytopenia

Transfusion of irradiated platelets to prevent bleeding

Prevent CMV infection

All blood products should be leukocyte-depleted

Prevention of transfusion-associated graft-versus-host disease (TA-GVHD)

All cellular blood components are irradiated

Input HSC cannot be irradiated or filtered with leukocyte-removing filters.

granulocyte infusion

Agranulocytosis may lead to severe infection after HSCT

Granulocyte infusion is effective in HSCT with fungal infection and ineffective antifungal treatment

platelet transfusion

After HSCT, unrelated donor HSCT, older patient age, GVHD, infection, etc. can all delay platelet recovery.

Platelet recovery after CBT is significantly longer than that of PBSCT or BMT

Indications for transfusion: The platelet count is lower than 20x109/L. The indications for transfusion are lower than 10x109/L for patients with stable condition and no infection or bleeding.

Transfusion of plasma, cryoprecipitate, and other coagulation factors

Bleeding requires plasma and cryoprecipitate transfusions

Infusion indications and volumes are the same as those for other diseases

ABO blood group incompatible HSCT blood transfusion

HSCs do not express mature red blood cell surface antigens, and donor-recipient blood type incompatibility does not increase the risk of transplant failure or GVHD.

ABO blood group incompatibility between donor and recipient

The main side does not match

reason

Recipient plasma contains antibodies against donor red blood cells

Elimination method

Remove red blood cells from bone marrow before transplantation, or perform plasma exchange on the recipient to remove antibodies or reduce titer

clinical manifestations

Delayed hematopoietic recovery: especially delayed recovery of the erythroid system, pure red aplastic anemia, and prolonged patient dependence on blood transfusions

Delayed hemolysis: occurs 40 to 60 days after transplantation. It is caused by the patient's residual anti-A or anti-B destroying newly generated and donor-derived red blood cells.

Blood transfusion principle

Transfused red blood cells have the same blood type as the recipient

Transfuse platelets or plasma with the same blood type as the donor or choose AB type platelets, plasma/cryoprecipitate

Secondary side does not match

reason

Donor plasma contains antibodies against recipient red blood cells

Elimination method

Plasma from bone marrow needs to be separated before transplantation

clinical manifestations

Lymphocytes in the transplant can produce antibodies against the recipient's red blood cells, causing delayed hemolysis after 1 to 3 weeks.

Blood transfusion principle

Transfusion of donor blood type red blood cells, recipient blood type or AB type platelets, plasma/cryoprecipitate

The primary and secondary sides are inconsistent

reason

Both the donor and recipient's plasma contain antibodies against the other's red blood cells.

Elimination method

Red blood cells and plasma need to be removed from bone marrow before transplantation

Blood transfusion principle

Transfusion of type O red blood cells, type AB platelets, plasma/cryoprecipitate