A historical perspective of allogeneic and autologous immunohaematopoietic stem cell transplantation in South Africa and a study of the non-haematologic consequences
Year: 2015
Type: dissertation
Study design: Observational Study
Abstract: Stem cell therapy was commenced after using rabbits as research models.Once this process was successful, the first human transplant was done in 1974.Certain prerequisites were necessary and these were achieved -a protected environment, an apheresis unit, protocols and accreditation with International Registries.Initially, unmanipulated bone marrow and peripheral blood stem cells were used together with immunosuppressive drugs followed by the use of Cyclosporin A then the addition of ex vivo Campath ® . AUDIT OF ACUTE ASSOCIATIONS (468 subjects in initial cohort) NEPHROLOGYCreatinine was used as an indication of renal function.Of the 76 available for analysis, 47% had acute kidney injury.Dialysis had a poor outcome as reported in the literature.Renal complications occurred frequently mostly due to infection.CARDIOLOGY A total of 119 individuals were available for analysis.Echocardiograms and electrocardiograms were part of pre-transplant assessment.Left ventricular systolic dysfunction predicted for increasing post transplant problems.Cardiac complications occurred at a lower frequency than other post-transplants side-effects consistent with the published data. DERMATOLOGYCases were evaluated on a daily basis and referred to a dermatologist when necessary.To confirm Graft-Versus-Host Disease (GVHD), a skin biopsy was done to differentiate it from drug hypersensitivity or viral infections.The exposure to ex vivo Campath ® significantly improved outcome by reducing the incidence and severity of GVHD.Quality of life was enhanced with substantial cost saving. GASTROENTEROLOGYForegut symptoms occurred in 90% of patients.Nutritional problems were encountered.Altered liver functions were relatively common attributable to drugs, sepsis and conditioning regimens.Liver biopsies were not performed in this series and endoscopy performed only when necessary. A STUDY ON LATE COMPLICATIONS (55 subjects)RESPIRATORY Spirometry and diffusing capacity were done in this cohort.All the lung function studies were within the predicted normal range apart from some marginal reduction in diffusing capacity.In none of these patients did late consequences such as Bronchiolitis Obliterans Organising Pneumonia and Late Onset Non-Infectious Pulmonary complications occur.Cytomegalovirus reactivation was common but early intervention prevented serious complications.
Author: Lucille Wood
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2144514187