Allogeneic hematopoietic stem cell transplantation: state of the art and new perspectives

Authors

  • OLLE RINGDÉN,

    Corresponding author
    1. Karolinska Institutet, Division of Clinical Immunology and Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Huddinge, Stockholm, Sweden
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  • KATARINA LE BLANC

    1. Karolinska Institutet, Division of Clinical Immunology and Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Huddinge, Stockholm, Sweden
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  • Invited Review.

Olle Ringdén, Karolinska University Hospital, Huddinge, Division of Clinical Immunology, F79, SE-141 86 Stockholm, Sweden. e-mail: Olle.Ringden@labmed.ki.se

Abstract

Allogeneic hematopoietic stem cell transplantation (ASCT) is a well-established therapy for leukemias and other immunohematopoietic disorders. In more recent years, bone marrow as stem cell source has been replaced by peripheral blood stem cells, which results in faster engraftment. Cord blood grafts are increasingly used. Conditioning prior to transplant may be myeloablative or nonmyeloablative. The latter is used preferentially in patients with high age or organ impairment. Isolation in the hospital during posttransplant pancytopenia has been challenged by promising results using home care. PCR diagnosis and new antifungal and antiviral treatment have reduced morbidity and mortality. The major threat to a successful outcome after ASCT is leukemic relapse. PCR techniques to detect recipient cells in the leukemic cell lineage or minimal residual disease enable early detection of leukemic cells. Donor lymphocyte infusions have an antileukemic effect. ASCT has shown an antitumor effect in metastatic cancers from breast, kidney, colon, ovaries, prostate and pancreas. Mesenchymal stem cells may be derived from bone marrow and have the capacity to differentiate into several mesenchymal tissues, such as bone, cartilage and fat. They seem to escape the immune system and have immunomodulatory effects in vitro and in vivo. To conclude, ASCT is a potent immunotherapy.

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