Autologous Hematopoietic Stem Cell Transplantation

Autologous HSCT uses stem cells from patients themselves. The principle behind both syngeneic and autol-ogous HSCT is that certain malignancies, such as leukemias, have a steep dose-response curve to chemotherapy and, to a relative degree, radiation.61-63 The major limitation to the administration of higher doses of chemotherapy or radiation, in order to obtain a maximal response, are the myelosuppressive effects of these therapies. Autologous, allogeneic, and syngeneic hematopoietic stem cells are primarily used as a "rescue" product to restore hematopoiesis after patients have received high-dose chemotherapy and/or radiation. The amount of chemotherapy and radiation that can be administered prior to transplant, referred to as the conditioning or preparative regimen, is limited due to associated toxicities to other organs. This limitation in the amount of therapy that can be delivered may permit the survival of resistant tumor cells, which accounts for the relapses that are observed after HSCT.64 65 Relapse rates are lower after allogeneic HSCT, as this form of transplant provides a potential

GVL effect at the expense of increased treatment-related morbidity and mortality, primarily through GVHD.19-21

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