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Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor
CPT4 code
Name of the Procedure:
Hematopoietic Progenitor Cell (HPC) Transplantation; Allogeneic Transplant
Summary
An allogeneic hematopoietic progenitor cell (HPC) transplantation involves transplanting stem cells from a healthy donor to a patient. These stem cells can develop into different blood cells, which can help treat certain medical conditions.
Purpose
This procedure is primarily used to treat various blood-related diseases, including certain types of cancer (like leukemia and lymphoma), bone marrow disorders, and some genetic conditions. The goal is to replace damaged or diseased cells with healthy ones from the donor to restore normal blood cell production.
Indications
- Blood cancers (e.g., leukemia, lymphoma, myeloma)
- Bone marrow failure syndromes (e.g., aplastic anemia)
- Certain genetic disorders (e.g., sickle cell disease, thalassemia)
- Severe immune deficiencies
Preparation
- Fasting may not be required, but specific dietary and medication instructions will be given.
- Pre-transplant evaluations including blood tests, imaging studies, and heart and lung function tests.
- Discussions about the risks and benefits with the healthcare team.
- Conditioning chemotherapy or radiation therapy may be administered to prepare the body for the new stem cells.
Procedure Description
- Collection of stem cells from a healthy donor, typically through peripheral blood stem cell collection or bone marrow aspiration.
- The patient undergoes conditioning treatment which may involve chemotherapy and/or radiation therapy.
- The harvested stem cells are infused into the patient's bloodstream through an intravenous (IV) line.
- The infused stem cells travel to the bone marrow, where they engraft and start producing new blood cells.
- Tools: IV infusion system, monitoring devices
- Anesthesia: Donor may receive local or general anesthesia for bone marrow aspiration. The patient does not typically need anesthesia for the infusion.
Duration
- Collection of stem cells from the donor may take several hours.
- Conditioning treatment for the patient can take several days.
- Actual stem cell infusion takes a few hours.
Setting
Performed in a hospital, particularly in specialized transplant units.
Personnel
- Hematologist/Oncologist
- Transplant Surgeon
- Registered Nurses
- Anesthesiologist (if donor undergoes bone marrow harvest)
- Laboratory Technicians
Risks and Complications
- Graft versus host disease (GVHD)
- Infections due to a weakened immune system
- Graft failure
- Organ damage (e.g., liver, lung)
- Bleeding and anemia
- Allergic reactions to medications
Benefits
- Potential cure or long-term remission of the underlying disease
- Improved blood cell production and immune function
- Enhanced quality of life and survival rates for certain conditions
Recovery
- Close monitoring in the hospital for several weeks post-transplant.
- Regular blood tests to check for engraftment and complications.
- Immune suppression medications to prevent GVHD.
- Months to years for full immune recovery.
- Restrictions on contact with infections and certain activities during recovery.
Alternatives
- Autologous stem cell transplantation (using the patient's own stem cells)
- Chemotherapy and/or radiation therapy alone
- Supportive care measures
- Pros: Autologous transplant reduces the risk of GVHD.
- Cons: Allogeneic transplant can offer the benefit of graft-versus-tumor effect.
Patient Experience
- During: Mild discomfort during stem cell infusion similar to receiving a blood transfusion.
- After: Fatigue, nausea, and risk of infections; pain management for any discomfort.
- Emotional support and counseling are often necessary due to the intense nature of the treatment and recovery process.