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Clinical Trials, U.S.: Hematological Cancers
Clinical Trials, U.S.: Hematological Cancers
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Clinical Trials, U.S.: Hematological Cancers
Hematological cancers are malignancies affecting all blood cells, bone marrow, and the lymphatic system. The number of people suffering from such malignancies has helped to generate a great deal of interest in the research for treatment, many of which are going into clinical trials to test for new approaches for treatment of hematological cancers. The hematopoietic stem cells found in the bone marrow can differentiate into all types of blood cells (white blood cells, platelets, and red blood cells) and have proven useful for the treatment of some blood malignancies such as some forms of leukemias. Hematopoietic stem cells are used by health professionals to rescue the effect of chemotherapy on blood cells. Currently, approaches and methods are being looked at by researchers for ways to improve the use of stem cells in the treatment of cancer and to find new methods for stem cell use in the treatment of cancers. Many clinical trials are currently ongoing around the world, most especially in the United States.
The list of hematological cancers treated with stem cells is extensive and includes acute lymphoblastic leukemia (ALL), acute biphenotypic leukemia, acute undifferentiated leukemia, acute myelogenous leukemia (AML), chronic myelogenous leukemia (CML), chronic lymphocytic leukemia (CLL), juvenile chronic myelogenous leukemia (JCML), juvenile myelomocytic leukemia (JMML), and non-Hodgkin’s lymphoma and Hodgkin’s disease. Though several types of stem cells are being utilized or investigated for cancer treatment, hematopoietic stem cells are the preferred choice for the treatment of hematological cancers.
Sources of Hematopoietic Stem Cells
The most important aspects of research relating to the treatment of hematological cancers are characterization, localization, and identification of these hematopoietic stem cells. The main source of these stem cells is the bone marrow; about 1 in every 100,000 cells in the bone marrow is a hematopoietic stem cell. Second, peripheral circulating blood is another good source of hematopoietic stem cells and increasingly is becoming a preferred option in the clinical setting. Finally, human umbilical cord blood and cells from the placenta are also sources of hematopoietic stem cells. Clinical researchers are focused on how to expand the number of cells available in a stem cell culture after isolation from these sources.
Clinical Application of Hematopoietic Stem Cells
The major application of hematopoietic stem cells is the treatment of blood cancers resulting from abnormal proliferation of blood cells. Chemotherapy is typically used to destroy the cancerous blood cells, which are then replenished with the introduction of hematopoietic stem cells. The stem cells differentiate and replace the lost blood cells. Another major application is in rescuing blood cells affected by chemotherapy and cancer drugs that often target all dividing cells. This approach is also applicable to both nonhematological cancers. Graft versus tumor reaction, a process in which transplanted cells destroy tumor cells, is another important mechanism by which transplanted hematopoietic cells help fight cancer.
Problems Affecting the Improvement of Old and Development of New Treatments Using Hematopoietic Stem Cells
Many clinical trials do not make it to actual clinical practice; one of the challenges faced by clinical researchers in the use of human stem cells is the difficulty in expanding the cell number to a usable quantity. Several studies have reported increased survival and efficiency in differentiation when larger numbers of stem cells are introduced to patients. The risk of donor-to-host infection, graft-versus-host diseases, and antigenic rejection occurring before transplanted stem cells initiate and maintain full blood cell production limits their clinical application in serious and fatal cases. On the other hand, the understanding and the knowledge of the conditions facilitating differentiation and plasticity of hematopoietic stem cells remains to be fully characterized. A better knowledge of stem cell biology will ultimately impact the usage of these cells in regular clinical practice.
Stages of Clinical Trials
All new medical procedures or pharmacological substances go through a series of clinical trials,
