Sources of hematopoietic stem cells

Hematopoietic stem cells may be obtained from the bone marrow, the peripheral blood, and from umbilical cord blood. Hematopoietic stem cells from bone marrow are used in both autologous and allogeneic stem cell transplantation, although far less frequently than in the past. Peripheral blood hematopoietic stem cells are used in approximately 90% of autologous HSCT and in approximately 70% of allogeneic HSCT.77 The predominance of this stem cell source is related to the relative ease in attainment and moderate improvement in the rate of hematopoietic recovery after infusion, as compared to hematopoietic stem cells derived from bone marrow. Hematopoietic stem cells from cord blood are collected immediately after delivery of a baby. A minimally acceptable cord blood unit dose is 1.7 X 105 CD34+ cells per the patient's weight in kilograms, to assure engraftment in the allogeneic HSCT setting.78 This criterion is a significant problem for adult patients, where the application of cord blood transplantation has been associated with delayed hematopoietic recovery, especially platelets; graft failure; and a relatively high treatment-related mortality compared to other sources of allogeneic hematopoietic stem cells.

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