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Reducing the toxicity of autologous haemopoetic stem cell transplants

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Wright, Nicole Eileen (2006) Reducing the toxicity of autologous haemopoetic stem cell transplants. Research Master thesis, University of Tasmania.

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Abstract

Post-thaw washing of cryopreserved blood stem cells is intended to reduce
side effects and is an increasingly common practice in Autologous Stem Cell
Transplantation ( ASCT). However, the potential advantages of this extra manipulation
have not been fully evaluated, and needs to be balanced against
the fact that patient morbidity has already been significantly lowered by
reductions in the reinfusion volume (achieved through refined harvesting,
mobilising and processing techniques) and improved patient pre-medication.
This study modified and validated the New York Cord Blood Banks washing
protocol (Rubinstein et al. 1995). Parameters validated included; cell
loss, overall viability, viable CD34+stem cell enumeration, clonogenic potential
and reduction in free haemoglobin content. The results demonstrate that
washing of cryopreserved stem cells improves the outcome of several key laboratory
parameters without a significant negative impact upon haematopoietic
stem cell (HSC) engraftment potential.
To determine whether a clinical need exists for the routine washing of
cryopreserved HSC autografts, a single institution, non-randomised clinical
trial was performed. Patients who met trial eligibility criteria were consented
for the washing of their ASCT graft, whereas all other transplant patients
received thawed unwashed blood stem cells in accordance with current practice.
Reinfusion associated side effects experienced by patients, their close
family members (carers) and nurses following the infusion of washed or unwashed
stem cells were assessed using both a Quality of Life (QOL) survey
and nursing documentation forms. The surveys were self-completed by the
patient, the nurse and the carer at intervals over a 24 hour period. Statistical
analysis of the QOL data demonstrated that washing was associated with
an improvement in several side effects associated with reinfusion including
flushing, nausea and unpleasant tastes for patients and unusual smells for
both carers and nurses. Furthermore, the clinical observations indicate that
the washing protocol reduces transplant associated hypertension in ASCT
patients and is an improvement on the reinfusion of unwashed HSC, which
has a significant correlation with increased blood pressure.
Consequently, this study has identified a number of circumstances in
which a post-thawing washing of HSC autografts is potentially beneficial
for the patients. The washing protocol reduces the amount of cellular debris
and DMSO reinfused as well as diminishing patient discomfort and therefore
should be considered in the event of large volume reinfusions, patient allergies
or where hemodilution may exacerbate existing cardiac issues. Furthermore,
post-thaw washing of HSC should also be contemplated in the event of unexpected
delays between autograft thawing and reinfusion as a strategy for
extending the viability of HSC.

Item Type: Thesis (Research Master)
Keywords: Hematopoietic stem cells, Cellular therapy, Cell transplantation, Chemotherapy
Copyright Holders: The Author
Copyright Information:

Copyright 2006 the Author - The University is continuing to endeavour to trace the copyright owner(s) and in the meantime this item has been reproduced here in good faith. We would be pleased to hear from the copyright owner(s).

Additional Information:

Available for library use only and copying in accordance with the Copyright Act 1968, as amended. Thesis (MMedSc)--University of Tasmania, 2006. Includes bibliographical references

Date Deposited: 04 Feb 2015 23:33
Last Modified: 11 Mar 2016 05:54
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