Stem cell transplants are used to treat a variety of diseases and illnesses, perhaps most famously leukemia. Statistics suggest that up to 1 million stem cell transplants have been performed around the world. Some of these transplants have been extremely successful, ultimately leading patients to a permanent remission for their disease. However, in other cases, the transplants may fail to achieve the desired results; and, in some other cases, the transplants may have deadly consequences. For example, some patients may die as a result of Graft-versus-Host Disease in which the donor’s stem cells attack the tissues of the recipient.
Recognizing that stem cell transplants are an important treatment tool for many patients and that it can fundamentally change the quality of life for so many people, researchers are beginning to look at ways that stem cell transplants can be optimized, ensuring the best possible outcome for everyone receiving stem cell transplants.
Optimizing Stem Cell Transplants
One piece of recent research from the University of Southern California and Stanford gives insight into the process of optimizing stem cell transplants. These researchers determined that stem cells do not behave in the same way in a transplant recipient, as they do in healthy individuals. In an individual who receives a transplant, stem cells may, according to researchers, behave in a way that could be described as unusual or extreme.
A Critical Find
One critical finding from the research was that not all transplanted stem cells flourish and reproduce in the patient’s body. In fact, the exact opposite seems to occur. Only a fraction of the cells reproduce in the desired way. The scientists referred to these special cells as super producers. But, even these super producers do not produce the full range of cells that one would expect to see in healthy bone marrow. Instead, they only produce certain types of cells. However, the production of these particular types of cells is often in a very impressive range.
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After determining this interesting fact about the transplanted stem cells, researchers turned their attention to attempting to determine why this was happening. One potential driving factor in this seemed to be radiation exposure. Intensive radiation therapy is the general go-to treatment prior to a patient receiving a stem cell transplant. Traditionally, doctors believe that this radiation primes the body to accept and not reject the foreign tissue (stem cells) that it is receiving. However, this same radiation seems to be the driving factor behind why many of the stem cells simply shut down on implantation.
Ideally, this will provide the medical community with more information on how it should proceed with the question of how stem cell transplants should be approached. If radiation therapy damages the ability of stem cells to thrive, then maybe a different prepping or priming mechanism should be utilized.
And More on Optimization
The above-mentioned study potentially provides critical evidence and a new approach to ensuring that more stem cell transplants will be successful, resulting in improved patient outcomes for even more individuals. But, this is not the only way that stem cell transplants can be optimized. Another way is to look at reasons why stem cell transplants may be unsuccessful.
According to statistics, one of the leading causes of death for individuals undergoing stem cell transplants is Graft-versus-Host Disease. Graft-versus-Host Disease is a process that may happen when a person receives stem cells from another individual (who may be either related or unrelated to them). Stem cells are beneficial in a variety of situations, including fighting cancerous cells, because stem cells contain a large number of T-cells. These T-cells attack cancerous cells, but, in certain circumstances, they may also attack other patient tissue. This attack against the patient’s tissue may have a wide variety of impacts, ranging from skin rashes to more
dangerous attacks on a person’s organs, such as: the GI tract or the liver.There are certain treatments, such as immunosuppressive therapy, that can be used to treat Graft-versus-Host Disease if it does develop and also to attempt to mitigate the risk of Graft-versus-Host Disease happening. An alternative treatment approach may exist. For example, if T-cells are the primary driving force behind the attack on a patient’s healthy tissues and organs, then potentially reducing the number of T-cells could be a way to minimize the risk of this happening (although it would need to be balanced out against the benefits that T-cells can play in fighting cancerous cells). There are new and emerging technologies that allow T-cells to be minimized either inside or outside the patient’s body.
Selecting The Right Donor For The Recipient
But, this is not the only way that stem cell transplants can be optimized to improve patient outcomes. Another part of the optimization process is doing a better job of selecting which donor and recipient will work best together. Traditionally, this has involved matching across a variety of indicators. However, recent research breakthroughs show that certain donor indicators may dramatically increase the risk of a patient developing Graft-versus-Host Disease. Doctors should approach these stem cell transplants with a healthy sense of skepticism, and, if they still decide to proceed with the transplant, they should be prepared to be extremely proactive to combat the risk of the recipient developing Graft-versus-Host.
What are some factors that doctors should be on the look-out for? Research shows that if the female donor gives stem cells to a male patient that there is a heightened risk of developing Graft-versus-Host Disease. Both advanced donor and recipient age may play a role in the likelihood of Graft-versus-Host. And, similarly, even in otherwise well-matched donors, Graft-versus-Host is more likely to occur when the donor and recipient are unrelated (compared with, for example, sibling donations). This does not mean that these types of donations should not happen. It simply means that everyone involved in the situation needs to fully understand both the benefits and risks involved.
Any information that can be collected by scientists, such as insight into Graft-versus-Host Disease will potentially further the goal of optimizing stem cell transplants.
Stem cell transplants are being used around the world to treat a wide variety of illnesses and diseases. For many people, these stem cell transplants offer newfound hope, sending diseases that were previously untreatable into remission. However, not everyone has positive outcomes from stem cell transplants. Sometimes these transplants fail to address the disease that they were designed to treat, and, in other cases, stem cell transplants can even have deadly consequences. As noted above, one of the primary causes of death is Graft-versus-Host Disease. To ensure that everyone benefits to the greatest possible degree from stem cell transplants, researchers are beginning to look at ways to optimize these stem cell transplants. As noted above, optimization can take many forms. For example, optimization may involve exploring what priming treatments prior to transplant are the most beneficial. Some recent research has indicated that the large amounts of radiation that are delivered prior to a transplant may mean that transplanted stem cells do not react in the ideal way in the recipient’s body, leading to suboptimal outcomes. Optimization may, on the other hand, also entail looking at the process through which recipients and donors are matched, looking at demographic factors and other issues that have not previously been considered.
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