A Study of the relation between Pre- Transplant serum ferritin, albumin, platelet count & CRP with early complications of Hematopoietic Stem Cell Transplantation in hematological malignancies

Abstract

Hematopoietic stem cell Transplantation (HSCT) has become the standard of care for many patients with defined congenital or acquired disorders of the hematopoietic system (Appelbaum, 2007). HSCT is now considered the corner stone in the treatment of hematological, and some non-hematological malignancies beside some other non-malignant disorders, being a curative option of treatment (Kyoo-Hyung et al and Je-Hwan, 2009). HSCT was started more than half a century ago as a standard therapeutic modality for a variety of malignant and non-malignant diseases, it has evolved from experimental bone marrow transplantation for rare cases with refractory acute leukemia, combined immune deficiency, or aplastic anemia to standard of care for patients with many congenital or acquired severe disorders of the hematopoietic system (Gratwohl et al., 2013). HSCT is based on the principle that hematopoietic stem cells (HSCs) can be intravenously infused then it will home and engraft in the stem cell niche within the bone marrow microenvironment, and then it will proliferate and differentiate to repopulate all lineages of the blood (Thomas, Buckner and Clift, 2009). The use of allogeneic hematopoietic cell transplantation (HSCT) is expanding, with the greatest proportion of growth seen in adults over the age of 50 years. This shifting demographics of HSCT recipients is a result of more effective supportive care and safer transplant methodologies, such as reduced-intensity (RIC) and non-myelo-ablative (NMA) conditioning regimens, which have improved transplant tolerability and reduced non-relapse mortality (NRM) (Kohrt et al., 2009). It is noted that the first successful allogeneic HSCT was done with bone marrow (BM) as the source of hematopoietic stem cells in 1968. In the subsequent 2 decades only bone marrow was used as the source of stem cells for transplantation. In the 1960s, experiments have shown that peripheral blood contains a small number of stem cells, which can be enriched by pre-treatment with certain chemotherapeutic drugs and hematopoietic growth factors. Therefore mobilized peripheral blood stem cells (PBSC) became another stem cell source for HSCT and PBSC has been increasingly used as it has certain advantages compared with BM. In 1978, umbilical UCB (UCB) was found to be a rich source of stem cells and was later successfully used for allogeneic HSCT at a lower cell dose infused compared with BM or PBSC (Daniel, 2013). Autologous HSCT is aimed to bridge hematopoietic failure after high dose chemotherapy for the treatment of selected hematopoietic and non-hematopoietic tumors.