Allogenic HSCT with frozen stem cells?

[UniversallyPersonal]

I am possibly having my second allogenic HSCT in not too long. Due to corona they will now most likely freeze the cells from the donor during the process to ensure that COVID is not causing any problems. (The risks are donor gets COVID and can't donate after I start the conditioning, or the donor already have COVID and they stem cells would not be usable, both risks will be manageable if they harvest earlier and freeze the cells.)

From my knowledge using fresh cells is the "golden standard" for allogenic HSCT. It concerns me to deviate from this and I would be interested in learning from the community if there is any experience or relevant research regarding the risks from deviating from the usual of using fresh cells. I am wondering if the cells that survive the freeze can in any way be compromised.

Since this is the second HSCT for me it is important that the process is as perfect as possible.

The first HSCT they changed the donor shortly before the procedure and this made me uncomfortable, as they had already booked the "perfect" donor, and there was not any necessity to move away from this. This time I want to make sure to air and clear any concerns before the process moves ahead.

[SofiaDeo]

Here's the research I could find:

This first reference from 2013 mentions concerns about graft-vs-host disease(GVHD)

pubmed.ncbi.nlm.nih.gov/237...

This second listed study abstract was published Aug 2020, so it's pretty recent. It addresses the GVHD, and concludes that it appears freezing the cells is a reasonable option. It's a retrospective analysis 2004-2018

sciencedirect.com/science/a...

[UniversallyPersonal in reply to SofiaDeo]

Thank you, I did see these and they seem to contradict on the graft timeline. One claims frozen is faster and other that frozen is slower.. :/

[SofiaDeo in reply to UniversallyPersonal]

Unfortunately there's not enough patients. If someone could fund a national or international study, we likely could draw better conclusions!

[UniversallyPersonal in reply to SofiaDeo]

That is one for the future! I think that HSCT will be part of treatment for a long time to come, even with all advancements in antibody and drug treatments.

[Jm954 Administrator]

Hi there,I can understand your concern but there are some advantages of having frozen stem cells, especially in this covid era, as you've already described.

Much of the research in this area is old because stem cells have been routinely stores for many years now and the cryopreservation of cord stem cells in now commonplace.

The use of frozen stem cells does not appear to impact on engraftment and outcomes for recipients despite the fact that there are almost certainly fewer stem cells. Stem cell numbers are important for successful engraftment but there is a range of acceptable numbers. Fresh v frozen does seem to impact on the type of GVHD you might experience with more intense acute GHVD in the fresh group.

These older abstracts have a bit more information

pubmed.ncbi.nlm.nih.gov/168...

pubmed.ncbi.nlm.nih.gov/237...

sciencedirect.com/science/a...

It sounds as though your team on are the ball and thinking ahead.

Good luck with your transplant, let us know how you are

Jackie

[UniversallyPersonal in reply to Jm954]

Thank you, yes it is a slight concern that the research is older as transplant processes have evolved in the last few years..

[SofiaDeo in reply to UniversallyPersonal]

Yes, and I am sure people are being monitored after the new procedures, unfortunately it will take a little time to gather data and publish results. SCT is somewhat uncommon, and the closer to 100 patients any study can get, the probability that the conclusions will hold in larger numbers of people goes up. The Aug 2020 publication that spanned 14 years only had 72 patients.

[Smith123456]

I have a 10/10 match donor if i need them Having said that it's been 2 years since i had the match but not the transplant. A donor can always drop out-there is no legal requirement for them to give. also nowadays the stem cells can be across the continent or overseas. they get drawn and shipped cold pack.

[UniversallyPersonal in reply to Smith123456]

So for you it is the only or one of few 10/10 matches for you? Making the storage of cells necessary and always available for a point where you might need them? I have several 10/10 matches and would in a non COVID situation get them freshly delivered.

[Smith123456 in reply to UniversallyPersonal]

actually at the time 2 years ago i was just diagnosed with 450,wbc and b-pll which is a form of high risk cll. it was just 2 weeks after diagnosis and 3 weeks after initial finding out. It was all a blur-and 3 weeks after that they, said they found 10/10 match . i never asked if more than one.. -i never had the transplant. 2 years later i have perfect bloods and they think negative mrd. I am on Imbruvica,venclexta,and finished 6 months of gazyvva infusions. i am not getting the best and constant mrd testing because i am NOT on a trial. I have no idea if this will last.