Stem Cells and Regenerative Medicine II Clinical stem

Clinical stem cell therapy Two examples: Established treatment: haematopoietic grafts Experimental treatment: b cell

Haematopoietic stem cell transplantation Source of cells: From bone marrow, iliac crest biopsy From

Haematopoietic cell grafts = bone marrow grafts o Overwhelmingly the most important type of

Haematopoietic grafts continued o Graft-versus-host disease (Gv. HD) arises from immunological attack by the

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Stem Cells and Regenerative Medicine - II

Clinical stem cell therapy Two examples: Established treatment: haematopoietic grafts Experimental treatment: b cell grafts from ESC

Haematopoietic stem cells

Haematopoietic stem cell transplantation Source of cells: From bone marrow, iliac crest biopsy From peripheral blood From umbilical cord blood Type of graft: Autologous: from own bone marrow Allogeneic: from donor bone marrow

Haematopoietic cell grafts = bone marrow grafts o Overwhelmingly the most important type of real stem cell therapy today. o 50, 000 grafts per year world wide. o Mostly for leukaemia and lymphoma, some for genetic diseases of blood o Chemo- or radiotherapy is given to destroy the tumour, this also destroys endogenous HSCs. o Graft repopulates host and generates new blood and immune cells for life.

Haematopoietic grafts continued o Graft-versus-host disease (Gv. HD) arises from immunological attack by the graft against the host. o To reduce this, allografts are HLA matched as much as possible. o Immunosuppression is also needed to minimise graft-versus-host disease. o “Graft-versus-tumour” effect hopefully removes the last of the tumour o Although a successful and life-saving therapy, allogeneic bone marrow transplant still carries a significant mortality, mostly from Gv. HD.