Cellular Support for the Oncology Patient [antikvár]

Bone Marrow Stem Cell Transplantation at the End of the Century The close of the century has seen a rapid expansion in the application of bone marrow stem cell transplantation in clinical medicine. This is in part due to everwidening applications of the procedure in malignant and nonmalignant diseases, and in part to increasing safety and success of both autologous and allogeneic transplantation. Table 1 outlines these current areas of development. Notably there is a growing interest in the use of high-dose immunosuppression and stem cell rescue for autoimmune disorders such as multiple sclerosis, rheumatoid arthritis and autoimmune cytopenias.1 The increase in allogeneic stem cell transplantation results from several recent developments. More transplants from donors other than HLA identical siblings are being carried out; first, because it is now much easier to rapidly identify a matched volunteer unrelated donor from national and international panels of over 4 millión individuals,2 second, cord blood banks further widen the possibility of alternative stem cell sources,3 and third, transplants from mismatched family donors are being performed with increasing success. The introduction of low-intensity, nonmyeloablative preparative regimens promises to extend allografting beyond the usual age cut-off of 55 to 60 years. The impact of these "minitransplants" on the transplant workload is likely to be significant because the peak incidence of many indolent but ultimately lethal hematologic malignancies occurs in individuals over 60 years of age.4 Finally, transplantation is being used more widely because it is becoming safer and cheaper - especially in the area of autologous peripheral blood stem cell transplantation (PBSCT), where many centers perform most of the procedures on an outpatient basis. In the area of allogeneic transplants, the use of PBSCT as the stem cell source alsó promises to reduce complications, shortening hospitál stays and reducing costs. For all these reasons it is therefore clear that the next century will see major expansions of bone marrow stem cell transplants in the treatment of a wide spectrum of disorders. However, none of these advances would have been possible without the introduction of improved stem cell and transplant technology and a better understanding of the process of hematologic and immuné reconstitution in autologous and allogeneic transplant recipients.