Multiple myeloma (MM) is a malignant plasma cell neoplasm that can not be cured with the conventional chemotherapy. Although new drugs, such as bortezomib, are highly effective in controlling the disease, the hematopoietic stem cell transplantation (HSCT) still should be performed, so as to increase the patients response and survival time. For over a decade, autologous HSCT has been a critical component in the treatment plan for newly diagnosed myeloma. The survival outcome with auto-HSCT seems to be highly dependent on the ability of this approach to enhance the depth of response. Maintenance therapy prolongs the responses after auto-HSCT by continuous administration of drug, such as thalidomide. However, patients invariably relapse after single auto-HSCT or double auto-HSCT. Allogeneic HSCT for myeloma has a potential for curing MM with the presence of a graft versus myeloma effect. Currently, allogeneic approaches should be considered in MM transplant procedure. Clinical data suggest that the mortality after allo-HSCT is definitely lower with the reduced-intensity regimens, but the relapse rate was higher than myeloablative regimens. Individual-adapted treatment strategy is benefited for MM transplant candidates. This article reviews the whole process of MM transplant candidates, including regimens for initial therapy, time of transplantation, choice of transplantation procedure and maintenance therapy.
Hematopoietic Stem Cell Transplantation ; methods ; Humans ; Multiple Myeloma ; surgery

OBJECTIVETo evaluate the effect of moxa-stick suffumigation in the hematology and hematopoietic stem cell transplantation (HSCT) wards with luminar flow.

METHODSThe plate exposure method was used to measure the effect of air-disinfection of moxa-stick suffumigation in hematology and HSCT wards. The yearly average qualified rates of air sampling in HSCT wards were evaluated from 2007 to 2010. To further investigate the disinfecting effect of moxa-stick suffumigation, the colony counts of common pathogens (including Staphylcoccus aureus and Pseudomonas aeruginosa) before and after moxa-stick suffumigation were compared.

RESULTSThe mean air quality rates of the HSCT wards with class 100 laminar flow were all above 90.0% (91.2%-96.2%) from 2007 to 2010. Moxa-stick suffumigation effectively decreased the presence of bacteria in the hematology ward's air (P<0.01). The most notable effect was the drastic reduction in the colony counts of Staphylococcus aureus and Pseudomonas aeruginosa on the blood plates exposed to air treated with moxa-stick suffumigation (77.1±52.9 cfu/m(2) vs 196.1±87.5 cfu/m(2), P<0.01; and 100.2±35.3 cfu/m(2) vs 371.5±35.3 cfu/m(2), P<0.01).

CONCLUSIONMoxa-stick suffumigation proved to be a reliable and effective airdisinfection method for hematology and HSCT wards, and hence, it should be employed extensively.

In the absence of significant improvement of disease-free survival (DFS) and overall survival (OS) by conventional chemotherapy, high dose chemotherapy in combination with hematopoietic stem cell transplantation has been increasingly used in the past decade for multiple myeloma (MM). Autologous stem cell transplantation (ASCT) was one of the most widely used methods in the treatment of MM. The patients who received ASCT may achieve a very good remission rate. ASCT may improve DFS but its application in clinic was limited by its high relapse rate. Tandem transplantation was feasible by its significant improvement of complete remission, but needed further evaluation. Allogeneic stem cell transplantation (Allo-SCT) has graft-versus-myeloma (GVM) effect, and provides molecular remission in about one third patients. It can only be offered to a small proportion of patients because of its high transplant-related mortality (TRM). Non-myeloablative transplantation is an attractive alternative tested currently in frontline treatment because of its GVM effect and low TRM.
Hematopoietic Stem Cell Mobilization ; Hematopoietic Stem Cell Transplantation ; methods ; Humans ; Multiple Myeloma ; therapy ; Prognosis ; Transplantation, Autologous ; Transplantation, Homologous

Allogeneic haematopoietic stem cell transplantation (allo-HCT) is the most effective curative therapy in myelodysplastic syndromes (MDS). Incidence of MDS increases with age, peaking in the seventh decade of last century. Despite improved consolidation chemotherapy regimens, the prognosis of MDS in patients beyond 60 years of age is dismal. The introduction of peripheral blood-derived stem cell grafts into allogeneic HSCT and the known anti-tumor effect of donor lymphocyte infusions paved the way for reduced-intensity conditioning (RIC) allogeneic hematopoietic stem-cell transplantation, which makes transplant possible in advanced age, significantly alleviates transplant-related organ toxicity and decreases non-relapse mortality. This article reviews the advanced development of reduced-intensity conditioning regimens in allogeneic hematopoietic stem cell transplantation for myelodysplastic syndromes and the future of reduced intensity conditioning hematopoietic stem cell transplants including feasibility of RIC allo-HSCT in treating patients with MDS, selection of MDS cases for RIC allo-HSCT, opportunity of RIC allo-HSCT, source of stem cells for RIC allo-HSCT, RIC regimen for allo-HSCT, evaluation of curative efficacy and prognosis, GVHD and graft versus MDS, and so on.
Hematopoietic Stem Cell Transplantation ; methods ; Humans ; Myelodysplastic Syndromes ; therapy ; Transplantation Conditioning ; methods ; Transplantation, Homologous

Hematopoietic Stem Cell Mobilization ; methods ; Humans ; Peripheral Blood Stem Cell Transplantation ; methods

Hematopoietic stem cell (HSC) is the first discovered and well studied tissue stem cell. HSC transplantation has been successfully applied to cure a variety of diseases of hematological and immunological systems. It has long believed that HSC and angioblast come from the common stem cell, the hemangioblast. Recently, HSC has been demonstrated to be able to differentiate into vascular endothelial cells. In animal in vivo models, HSC transplantation can promote angiogenesis and improve limb ischemia. Several pilot clinical studies have shown that transplantation of bone marrow and granulocyte colony stimulating factor mobilized peripheral blood HSC promoted vascular reconstitution in ischemic limbs. Umbilical cord blood has been an important source of HSC for clinical transplantation. Animal studies have demonstrated the efficiency of cord blood HSC transplantation in improving critical limb ischemia. These studies have provided evidences that HSC can be used for the treatment of vascular diseases.
Animals ; Cell Differentiation ; Extremities ; blood supply ; Hematopoietic Stem Cell Mobilization ; methods ; Hematopoietic Stem Cell Transplantation ; methods ; Hematopoietic Stem Cells ; cytology ; Humans ; Ischemia ; therapy

Mesenchymal stem cells (MSCs) have been officially approved in many countries to treat graft-versus-host disease, autoimmune disorders and those associated with tissue regeneration after hematopoietic stem cell transplantation. Studies in recent years have confirmed that MSC acts mainly through paracrine mechanism, in which extracellular vesicles secreted by MSC (MSC-EV) play a central role. MSC-EV has overwhelming advantages over MSC itself in the setting of adverse effects in clinical application, indicating that MSC-EV might take the place of its parent cells to be a potentially therapeutic tool for "cell-free therapy". The pharmaceutical properties of MSC-EV largely depend upon the practical and optimal techniques including large-scale expansion of MSC, the modification of MSC based on the indications and the in vivo dynamic features of MSC-EV, and the methods for preparing and harvesting large amounts of MSC-EV. The recent progresses on the issues above will be briefly reviewed.
Humans ; Extracellular Vesicles ; Hematopoietic Stem Cell Transplantation/adverse effects* ; Mesenchymal Stem Cell Transplantation/methods* ; Mesenchymal Stem Cells ; Pharmaceutical Preparations

Adult ; Hematopoietic Stem Cell Transplantation ; methods ; Humans ; Male ; Primary Myelofibrosis ; surgery ; Transplantation Conditioning ; methods

Hematopoietic stem cell transplantation (HSCT) is the only way to cure myelodysplastic syndromes. At present there are several myelodysplastic syndromes scoring systems, including the International Prognostic Scoring System (IPSS), WHO Prognostic Scoring System (WPSS) and Simplified MDS Risk Score. These score systems can not only predict the probability of transplant success, but also help to determine the time of transplantation. For the older patient with serious complication, a suitable conditioning regimen can lower the risk of treatment-related mortality. Complication management, individualized conditioning regimen, optimal timing of transplantation and donor selection should improve the curative effect of HSCT. However, post-transplantation relapse and graft-versus-host disease (GVHD) remain to be solved and further investigations are needed. In this review the MDS scoring system, factors influencing HSCT efficacy, the selection of HSCT donors and timing, the preconditioning intensity before HSCT and evaluation of HSCT efficacy are summarized.
Hematopoietic Stem Cell Transplantation ; methods ; Humans ; Myelodysplastic Syndromes ; surgery ; Transplantation Conditioning ; methods ; Treatment Outcome

Humans ; Fetal Blood ; Hematopoietic Stem Cell Transplantation ; Transplantation, Homologous ; Anemia ; Cord Blood Stem Cell Transplantation/methods* ; Graft vs Host Disease