ABSTRACT
The primary source of hematopoietic stem and progenitor cells for use in autologous and allogeneic transplantation had been bone marrow, but this has changed over the past decade. During this period, there has been increasing use of peripheral blood containing mobilized stem and progenitor cells as a source of these cells for transplantation (Table 1) (1,2). This product is variously referred to as peripheral blood stem cells (PBSC), peripheral blood progenitor cells, or given the shorthand designation “stem cells.” Although each cell source used for hematopoietic transplantation contains stem cells, when the term “stem cells” is used without a qualifier, it is usually referring to PBSC. Even in pediatrics, there has been increasing and wide use of PBSC for transplant. As in adult transplant, PBSC have become the standard of care in autologous transplant, even for diseases such as neuroblastoma, where the mean age of the patient population is under 3 years (3-9). The pros and cons of the use of PBSC in pediatric allogeneic transplant are beyond the scope of this chapter and remain controversial (10). Issues include the use of minor siblings as stem-cell donors (11), well established in the case of bone marrow donation but somewhat less well characterized in the setting of PBSC collection (12), use of G-CSF to mobilize cells in the minor sibling donor (11,13), and the challenges of PBSC collection in the small child (detailed below).
