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Stephen J. Forman, MD

Stephen J. Forman, MD

Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center

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Hematopoietic cell transplantation (HCT) is the IV infusion of hematopoietic stem and progenitor cells designed to establish marrow and immune function in patients with a variety of acquired and inherited malignant and nonmalignant disorders.

Clonogenic tumor cells contained within hematopoietic stem cell
(HPC) grafts may contribute to relapse following autologous transplantation.
Graft purging involves either in vivo or ex vivo HPC manipulation
in order to reduce the level of tumor cell contamination.
Some phase II trials suggest that patients who receive purged products
may have a superior transplant outcome. Phase I trials demonstrate
the feasibility of purging methods including ex vivo graft incubation
with chemotherapeutic drugs, monoclonal antibodies and complement,
and CD34+ cell selection. A phase II trial in follicular non-Hodgkin’s
lymphoma demonstrates that patients who receive HPC products purged
negative for bcl-2 gene rearrangements have a superior outcome, compared
with patients who receive polymerase chain reaction (PCR)-positive
products. This finding, however, has not been confirmed in a randomized
trial. HPC purging has demonstrated no benefit in a phase III
trial in myeloma. Phase II trials in acute myelogenous leukemia show
comparable outcomes for patients who receive either purged or
unpurged HPC grafts. Limitations of purging include possible progenitor
cell loss, delayed engraftment, and qualitative immune defects following
transplant. Data to justify routine use of HPC graft purging are
insufficient. Phase I and II data support development of phase III trials
of both in vivo and in vitro purging methods.

With the increasing success
of both autologous and allogeneic
marrow transplantation
in achieving cure of inherited
and acquired disorders, the number
of people who have become longterm
survivors has steadily increased
worldwide. Concomitant with this
increase has been greater attention to
the long-term health needs of these
recipients. Many studies have outlined
the problems experienced by
long-term survivors and have better
informed physicians about the medical
problems that may require intervention
and consultation.[1]

Hematopoietic Cell Transplantation, edited by Drs. Thomas, Blume, and Forman, is an excellent updated second edition of their comprehensive textbook designed for both practitioners involved in transplantation and those interested in the science of stem-cell transplantation.

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