Abstract
Impaired hematopoiesis is a serious complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Bone marrow aplasia and peripheral cytopenias arise from primary and secondary graft failure or primary and secondary poor graft function. Chimerism analysis is useful to discriminate these conditions. By determining the pathogenesis of impaired hematopoiesis, a timely and appropriate treatment can be performed. Hematopoietic system principally consists of hematopoietic stem cells and bone marrow microenvironment termed niches. Abnormality in hematopoietic stem and progenitor cells and/or abnormality in the relevant niches give rise to hematological diseases. Allo-HSCT is intended to cure each hematological disease, replacing abnormal hematopoietic stem cells and bone marrow niches with hematopoietic stem cells and bone marrow niches derived from normal donors. Therefore, treatment for graft failure and poor graft function after allo-HSCT is required to proceed based on determining the pathogenesis of impaired hematopoiesis. Recent progress in this area suggests promising treatment manipulations for graft failure and poor graft function.
Highlights
Allogeneic hematopoietic stem cell transplantation is an essential therapy to cure many hematological diseases
Chimerism analysis based on polymerase chain reaction amplification of variable number tandem repeat or short tandem repeat allows the detection of imminent graft failure, poor graft function, or disease recurrence [7,8]
Tapering and withdrawal of immunosuppressive drugs or donor-lymphocyte infusion (DLI) are occasionally performed, the effect appears to be vague. These results suggest that the extent of donortype chimerism in lineage-specific cells show an impact on outcome in allo-HSCT
Summary
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an essential therapy to cure many hematological diseases. Primary graft failure indicates no initial donor engraftment and no initial hematopoiesis, resulting in hypocellular marrow and peripheral cytopenias under mixed or full recipient chimerism. A temporal hematological recovery is seen after initial donor engraftment in secondary graft failure, showing hypocellular marrow and peripheral cytopenias under mixed or full recipient chimerism. Primary poor graft function occurs after initial donor engraftment but no initial hematological recovery, resulting in hypocellular marrow and peripheral cytopenias under full donor chimerism. Hypocellular marrow and peripheral cytopenias are seen after initial donor engraftment and initial hematological recovery in secondary poor graft function under full donor chimerism. I will focus on the pathogenesis of impaired hematopoiesis after allo-HSCT and possible therapeutic manipulations
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