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Manual of Stem Cell and Bone Marrow Transplantation
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Research Program Contacts. Researchers hope to use stem cells to repair or replace cells or tissues damaged or destroyed by such disorders as Parkinson disease, diabetes, and spinal injuries.
By triggering certain genes, researchers may be able to cause the stem cells to specialize and become the cells that need to be replaced. Induced pluripotent stem cells certain cells from adults that can be altered to act like stem cells. Embryos: During in vitro fertilization, sperm from the man and several eggs from the woman are placed in a culture dish. The sperm fertilizes the egg and the resulting cell divides, forming an embryo. The rest are discarded or frozen to be used later if needed. Stem cells can be obtained from the embryos that are not used.
Because the embryos then lose the ability to grow into a complete human being, the use of stem cells from embryos is controversial. But researchers think that these stem cells have the most potential for producing different kinds of cells and for surviving after transplantation. Fetuses: After 8 weeks of development, an embryo is called a fetus. Stem cells can be obtained from fetuses that have been miscarried or aborted.
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Umbilical cord: Stem cells can be obtained from the blood in the umbilical cord or placenta after a baby is born. These stem cells can produce only blood cells and have been used for transplantation only in recent years. Children and adults: The bone marrow and blood of children and adults contain stem cells. These stem cells can produce only blood cells.
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These stem cells are most often used for transplantation. Induced pluripotent stem cells: Scientists are developing ways of enabling inducing other cells such as a blood or skin cell to act as stem cells. These cells are taken from adults.
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One way to induce these cells is to inject them with material that affects their genes, a process called reprogramming. Stem cell transplantation can be used as part of the treatment for blood disorders such as leukemia , certain types of lymphoma including Hodgkin lymphoma , aplastic anemia , thalassemia , sickle cell disease , and some congenital metabolic or immunodeficiency disorders such as chronic granulomatous disease.
Stem cell transplants may also be given to people who have been treated with high doses of chemotherapy or radiation therapy for certain cancers. Such treatments destroy bone marrow, which produces stem cells. Occasionally, stem cell transplants can be used to replace bone marrow cells that are destroyed during treatment of cancers in organs, such as breast cancer or neuroblastoma a common childhood cancer that develops from nerve tissue.
Doctors are studying how to use stem cell transplantation to treat some autoimmune disorders, such as multiple sclerosis. The procedure prolongs life in people with multiple myeloma. It is less effective for breast cancer. If people with cancer are being given their own stem cells, the cells are collected before chemotherapy or radiation therapy, which can damage stem cells. The cells are injected back into the body after the treatment.
If the stem cells come from a donor, the recipient is given drugs to suppress the immune system immunosuppressants before stem cells are transplanted. Stem cells from adults can be obtained from blood during an outpatient procedure. First, a few days before stem cells are obtained, the donor is given drugs that cause the bone marrow to release more stem cells into the bloodstream called colony-stimulating factors. Then blood is removed through a catheter inserted in one arm and is circulated through a machine that removes stem cells. The rest of the blood is returned to the person through a catheter inserted in the other arm.
Usually, about six 2- to 4-hour sessions over a period of several days are needed, until enough stem cells are obtained. Stem cells can be preserved for later use by freezing them. For bone marrow transplantation, the donor is given a general or local anesthetic. Removal of bone marrow takes about 1 hour.
After discharge from the hospital, follow-up visits are scheduled at regular intervals. Most people need at least 1 year to recover. As a result, the risk of infection is very high for about 2 to 3 weeks—until the donated stem cells can produce enough white blood cells to protect against infections. The risk of infection can be reduced by keeping the recipient in isolation for a period of time until the transplanted cells begin to produce white blood cells.
During this time, everyone entering the room must wear masks and gowns and wash their hands thoroughly. Colony-stimulating factors, which stimulate the production of blood cells including white blood cells, which help fight infection.