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Author: Dr Leah Jones, Medical Registrar, Christchurch, New Zealand. Medical Editor: Dr Helen Gordon, Auckland, New Zealand. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. September 2020.
Autologous stem cell transplantation is a procedure in which the patient’s stem cells are collected and are later injected back into the patient following chemotherapy or radiation therapy.
Autologous stem cell transplantation is used predominantly in haematological malignancies (lymphoma and leukaemia). It is sometimes used in autoimmune diseases including systemic lupus erythematosus, systemic sclerosis, and dermatomyositis, which have cutaneous manifestations.
Autologous stem cell transplantation is also known as autologous haematopoietic cell transplant and an autologous bone marrow transplant.
Autologous stem cell transplantation enables higher doses of chemotherapy to be used than would be otherwise tolerated due to the toxicity of treatment on the bone marrow.
Autologous stem cell transplantation is well established in the treatment of various haematological malignancies with growing experience and use in solid tumours and autoimmune conditions.
There is experience and emerging clinical-trial evidence for the use of autologous stem cell transplantation in the treatment of autoimmune conditions. These include:
Contraindications for autologous stem cell transplantation can include:
Prior to the transplant, a detailed health workup is required, followed by pretransplant induction treatment which will vary depending on the condition being treated. Autologous stem cell transplantation then involves multiple steps.
Following the transplant, red blood cell and platelet transfusions may be required until the subsequent pancytopenia resolves. Consolidation and maintenance treatment may follow, depending on the underlying condition.
Autologous stem cell transplantation is well established for use in lymphoma and plasma cell disorders. Overall survival and progression-free survival is improved for plasma cell myeloma, non-Hodgkin lymphoma, and Hodgkin lymphoma when treated with autologous stem cell transplantation with chemotherapy compared to chemotherapy alone.
Autoimmune conditions with dermatological manifestations with the best evidence for autologous stem cell transplantation use are:
The main disadvantages of autologous stem cell transplantation include:
Side effects of autologous stem cell transplantation include:
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