Iron Overload and Hematopoetic Stem Cell Transplantation

Yeğin, Zeynep Arzu; Sucak, Gülsan Türköz; Demirer, Taner

doi:10.5772/53819

Cited by 1 publication

(1 citation statement)

References 83 publications

(256 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although MAC affords maximum intensity for marrow ablation making the environment conducive to engraftment, it does expose SCD patients in a NMD situation to high doses of chemotherapy with agents such as busulfan and cyclophosphamide that have well described short-term and long-term toxicities based on exposure [22]. Further, disease characteristics such as iron overload after chronic red cell transfusion therapy can add to conditioning-related morbidity such as veno-occlusive disease [23]. Reduced toxicity (RTC), RIC and NMA regimens aim to reduce exposure to ablative chemotherapy doses by substituting immune suppression for myelosuppression.…”

Section: The Impact Of Conditioning On Chimerism Statusmentioning

confidence: 99%

Mixed donor chimerism following stem cell transplantation for sickle cell disease

Shah,

Rangarajan,

Ngwube

et al. 2023

Current Opinion in Hematology

View full text Add to dashboard Cite

Sickle cell disease is a debilitating hemoglobinopathy with high morbidity and mortality. Hematopoietic stem cell transplantation (HCT) is curative, but the presence of mixed donor/recipient chimerism post-HCT raises concerns about disease control long-term. Mixed donor/recipient chimerism is reported in significant numbers even after aggressive HCT conditioning regimens. Post-HCT, adequacy of donor erythropoiesis is crucial for disease control. This review explores the relationship between mixed donor/recipient chimerism and outcomes post-HCT. Serial chimerism analysis in lineage specific manner in erythroid or myeloid cells post-HCT predicts for disease control and HCT success. Adequate and stable donor-derived erythropoiesis is essential for reversing SCD manifestations. Myeloid lineage chimerism mirrors erythropoiesis is commercially available, and a reliable indicator of adequacy. Using this tool, the minimum threshold of donor chimerism is required to prevent SCD-related complications and maintain sickle hemoglobin less than 50% is approximately 20–25% even when a donor has Hb S trait. Curative interventions should, at a minimum, meet this goal long-term. Achieving a balance between successful engraftment while minimizing toxicity is important in patients vulnerable because of age or preexisting morbidity and is the objective of recent clinical trials. As HCT and gene therapies evolve, efficient long-term follow-up that includes durability assessment of mixed donor/recipient chimerism will be crucial.

show abstract

Section: The Impact Of Conditioning On Chimerism Statusmentioning

confidence: 99%