New cellular therapies: Is there a role for transfusion services?

New forms of cellular therapy are emerging and are being tested in clinical trials: dendritic cells sensitized with tumour antigen and cytotoxic lymphocytes stimulated with a tumour antigen to treat some forms of cancer and natural killer (NK) cells to treat tumours lacking their own HLA-class I antigens. Mesenchymal stroma cells (MSC) are potentially important for the treatment of graft-versus-host disease (GVHD) and autoimmune diseases because of their capacity to negatively modulate the immune response. They also might be used as vehicles for the treatment of cancer, because they home specifically into tumours. Finally, regenerative therapy with stem cells may become important in the future. The role of transfusion services in therapies dependent on the use of haematopoietic stem/progenitor cells is fairly clear. However, although the above new therapies are a subject of discussion in transfusion circles and articles on the subject are published in journals devoted to transfusion medicine – a section on the subject has recently been created in this journal – the role that transfusion services/departments will play in their practice is less clear. It seemed of interest to learn the opinion of the experts on this important issue. To obtain the relevant information, the following questions were sent to transfusion services. We received 14 contributions to this Forum. Question 1 . Are or will your transfusion centre or department of transfusion medicine participate in the above cellular therapies? If so, in which part of the procedure are, or will you be involved, e.g. the isolation, preparation, culture or expansion of the cells involved, their preservation, etc.? Question 2 . If you do or will participate, with which other disciplines will you cooperate? Question 3 . If you do not think that transfusion services will take part in the procedure, which disciplines will cooperate for these new therapies? As was to be expected, it is essential to read the answers provided by the participants to fully appreciate their experience with the subject and their ideas about the future. Nevertheless, some general conclusions are warranted. The main conclusion is that in nearly all the countries from which information was obtained, transfusion services/departments are already playing, or are expected to play an important role in the practice of these new cellular therapies. It is felt that it would be an irresponsible waste if the experience obtained with cells for transfusion purposes and with haematopoietic stem/ progenitor cells would not be used for these new developments. Thus, the tasks of the blood transfusion services are or will be: the separation of cells, their culture and in vitro expansion, cryopreservation, to guarantee the safety of the products and quality control. Even the handling of tissues for transplantation is expected to take place in transfusion centres, e.g. in France. Cooperation will mainly be with departments of haematology and oncology and, when reparative medicine with stem cells will become a fact, with departments of cardiology, neurology, paediatrics and probably others. It is of interest that in the European Union there are European Directives for cells used in the new therapies and tissues, separate from those for blood components used for transfusion. Thus, the answer to the above question is that blood transfusion services/departments are already or will play an important role in the new cellular therapies.