Department of Hematology/Oncology, Smilow Cancer Hospital, Yale New Haven Health, New Haven, Connecticut.
Department of Hematology/Oncology and Bone Marrow Transplantation, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina.
Biol Blood Marrow Transplant. 2019 Oct;25(10):e305-e309. doi: 10.1016/j.bbmt.2019.07.003. Epub 2019 Jul 8.
Bloodless autologous hematopoietic cell transplantation is associated with risks of severe bleeding and profound anemia. RBC or platelet transfusions are often used to prevent these hematologic complications. However, in patients such as Jehovah's Witnesses who refuse major blood components, the lack of transfusion support is not an absolute contraindication to an autologous hematopoietic cell transplant. Pennsylvania Hospital performed the world's first bloodless hematopoietic cell transplant more than 15 years ago and has gradually improved its technique with a sizable patient population. Erythropoiesis-stimulating agents were successfully employed as part of their pretransplant regimen to prevent severe anemia. Thrombopoietin agonists' potential role in bloodless transplant is also currently being explored. Although there is limited literature, available reports in combination with physiologic reasoning may support the use of these growth factors to promote transplant success. These agents offer potential benefit and may be of utility in minimizing complications of a bloodless transplant. In this review, we summarize the available literature and offer insight into how we may incorporate growth factors to allow bloodless autologous hematopoietic cell transplantation to be an available option to patients who may otherwise be denied.
无血自体造血细胞移植与严重出血和严重贫血的风险相关。通常使用红细胞或血小板输注来预防这些血液学并发症。然而，对于拒绝使用主要血液成分的耶和华见证人等患者，缺乏输血支持并不是自体造血细胞移植的绝对禁忌症。宾夕法尼亚医院在 15 年前进行了世界上首例无血造血细胞移植，并逐渐在大量患者中改进了其技术。促红细胞生成素刺激剂成功地被用作移植前方案的一部分，以预防严重贫血。血小板生成素激动剂在无血移植中的潜在作用也在探索中。尽管文献有限，但结合生理推理的现有报告可能支持使用这些生长因子来促进移植成功。这些药物具有潜在的益处，可能有助于减少无血移植的并发症。在这篇综述中，我们总结了现有文献，并深入探讨了如何将生长因子纳入其中，以使无血自体造血细胞移植成为可能，否则这些患者可能会被拒绝。
