Haematopoietic Stem CellS can be isolated from bone marrow, peripheral blood after mobilization, and umbilical cord blood. Bone marrow source is considered as the gold standard for more than three decades. It is aspirated from posterior iliac crest under general or regional anaesthesia. Generally requires 10–20 ml/kg of marrow for adult recipients. The donors can be primed with filgrastim prior to harvest which may improve HSC recovery in heavily pretreated patients.
Advantages of bone marrow source:
i. Fewer T cells in graft compared with PB source that decreases risk of chronic graft-versus-host disease.
ii. Decreased mortality in children and adolescents.
Disadvantages of bone marrow source:
i. Requires operating room and spinal or general anaesthesia.
ii. Increased morbidity to donors: Potential risks include pain, infection, blood loss, nerve damage. The donor may require blood transfusions for young paediatric donors.
iii. Slower neutrophil and platelet engraftment in the recipient compared to peripheral blood source.
iv. Increased risk of relapse compared to peripheral blood source.
Target cell dose:
i. Target cell dose 200,000,000 TMNC/kg recipient body weight.
ii. Minimum 100,000,000 TMNC/kg recipient body weight.
iii. Retrospective studies show better haematopoietic recovery, decreased treatment related mortality, and improved overall survival when CD34 cell dose > 3,000,000/kg.