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Management of recipient hematopoietic progenitor cell donor search and cell acquisition
CPT4 code
Name of the Procedure:
Management of Recipient Hematopoietic Progenitor Cell Donor Search and Cell Acquisition
Common name(s): Stem Cell Donor Search and Collection, Hematopoietic Stem Cell Procurement
Summary
This procedure involves finding a suitable donor for hematopoietic progenitor cells (stem cells) and collecting those cells for transplantation. This is a key step in treatments for certain blood disorders and cancers.
Purpose
The primary goal is to identify and obtain healthy stem cells for transplant into a patient with conditions such as leukemia, lymphoma, or aplastic anemia. This helps restore the patient's ability to produce healthy blood cells.
Indications
- Patients with blood cancers (leukemia, lymphoma)
- Patients with severe anemia or other blood disorders
- Patients needing stem cell replacement due to high-dose chemotherapy or radiation
Preparation
- Patients may need to undergo blood tests and diagnostic imaging to assess overall health.
- Pre-procedure consultations with a hematologist and transplant team.
- Possible adjustments to current medications as advised by the healthcare provider.
Procedure Description
- Donor Search:
- The process begins with finding a matching stem cell donor through a registry or among relatives.
- Donor Pre-screening:
- Health assessment and compatibility testing, including HLA (human leukocyte antigen) matching.
- Cell Acquisition:
- Peripheral Blood Stem Cell (PBSC) collection: Donors receive injections of growth factors to increase stem cells in the blood. Cells are then collected via apheresis.
- Bone Marrow Harvest: Under anesthesia, stem cells are collected directly from the donor's bone marrow using a needle.
Duration
- Donor search can take several weeks to months.
- PBSC collection typically takes 4-5 hours on a single day.
- Bone Marrow Harvest may take 1-2 hours of surgical time.
Setting
- Donor search and initial consultations: outpatient clinic.
- Cell acquisition: specialized medical centers or hospitals with apheresis units or operating rooms.
Personnel
- Hematologists
- Transplant coordinators
- Nurses specialized in apheresis or surgical procedures
- Anesthesiologists (for bone marrow harvest)
Risks and Complications
- Donor risks: Fatigue, bone pain (for PBSC donation), and infection at the collection site.
- Rare complications include reactions to anesthetics (for bone marrow harvest) and prolonged pain or bleeding.
- Recipient risks: Graft-versus-host disease (GVHD), infections, or complications from the transplant.
Benefits
- Potential cure or remission of blood cancers and disorders.
- Restoration of normal blood cell production.
- Reduced long-term dependency on transfusions and medications.
Recovery
- Donors: Mild side effects typically resolve within a few days to weeks. Follow-up appointments to ensure recovery.
- Patients: Hospitalization for several weeks post-transplant, with ongoing monitoring. Recovery can take several months, with restrictions on physical activities and close follow-up care.
Alternatives
- Autologous stem cell transplant (using patient's own cells).
- Supportive treatments without transplant (medications, blood transfusions).
- Each alternative has varying success rates, risks, and potential benefits compared to donor stem cell transplantation.
Patient Experience
- During the donor search and cell acquisition, the patient may experience anxiety and anticipation.
- Post-transplant recovery involves close monitoring, potential side effects from conditioning therapy, and pain management.
- Emotional support and counseling are available to help manage stress and expectations during the transplant journey.