Hematopoietic Stem Cell Transplantation—50 Years of Evolution and Future Perspectives
Hematopoietic stem cell transplantation is a highly specialized and unique medical procedure. Autologous transplantation allows the administration of high-dose chemotherapy without prolonged bone marrow aplasia. In allogeneic transplantation, donor-derived stem cells provide alloimmunity that enable...
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| Format: | Article |
| Language: | English |
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Rambam Health Care Campus
2014-10-01
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| Series: | Rambam Maimonides Medical Journal |
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| Online Access: | http://rmmj.org.il/Pages/ArticleHTM.aspx?manuId=444 |
| _version_ | 1818981021044965376 |
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| author | Israel Henig Tsila Zuckerman |
| author_facet | Israel Henig Tsila Zuckerman |
| author_sort | Israel Henig |
| collection | DOAJ |
| description | Hematopoietic stem cell transplantation is a highly specialized and unique medical procedure. Autologous transplantation allows the administration of high-dose chemotherapy without prolonged bone marrow aplasia. In allogeneic transplantation, donor-derived stem cells provide alloimmunity that enables a graft-versus-tumor effect to eradicate residual disease and prevent relapse. The first allogeneic transplantation was performed by E. Donnall Thomas in 1957. Since then the field has evolved and expanded worldwide. New indications beside acute leukemia and aplastic anemia have been constantly explored and now include congenital disorders of the hematopoietic system, metabolic disorders, and autoimmune disease. The use of matched unrelated donors, umbilical cord blood units, and partially matched related donors has dramatically extended the availability of allogeneic transplantation. Transplant-related mortality has decreased due to improved supportive care, including better strategies to prevent severe infections and with the incorporation of reduced-intensity conditioning protocols that lowered the toxicity and allowed for transplantation in older patients. However, disease relapse and graft-versus-host disease remain the two major causes of mortality with unsatisfactory progress. Intense research aiming to improve adoptive immunotherapy and increase graft-versus-leukemia response while decreasing graft-versus-host response might bring the next breakthrough in allogeneic transplantation. Strategies of graft manipulation, tumor-associated antigen vaccinations, monoclonal antibodies, and adoptive cellular immunotherapy have already proved clinically efficient. In the following years, allogeneic transplantation is likely to become more complex, more individualized, and more efficient. |
| first_indexed | 2024-12-20T17:24:41Z |
| format | Article |
| id | doaj.art-4577b066ac9a44c7b6f5deafa8774ed5 |
| institution | Directory Open Access Journal |
| issn | 2076-9172 |
| language | English |
| last_indexed | 2024-12-20T17:24:41Z |
| publishDate | 2014-10-01 |
| publisher | Rambam Health Care Campus |
| record_format | Article |
| series | Rambam Maimonides Medical Journal |
| spelling | doaj.art-4577b066ac9a44c7b6f5deafa8774ed52022-12-21T19:31:37ZengRambam Health Care CampusRambam Maimonides Medical Journal2076-91722014-10-0154e002810.5041/RMMJ.10162Hematopoietic Stem Cell Transplantation—50 Years of Evolution and Future PerspectivesIsrael Henig0Tsila Zuckerman1Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, IsraelDepartment of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, IsraelHematopoietic stem cell transplantation is a highly specialized and unique medical procedure. Autologous transplantation allows the administration of high-dose chemotherapy without prolonged bone marrow aplasia. In allogeneic transplantation, donor-derived stem cells provide alloimmunity that enables a graft-versus-tumor effect to eradicate residual disease and prevent relapse. The first allogeneic transplantation was performed by E. Donnall Thomas in 1957. Since then the field has evolved and expanded worldwide. New indications beside acute leukemia and aplastic anemia have been constantly explored and now include congenital disorders of the hematopoietic system, metabolic disorders, and autoimmune disease. The use of matched unrelated donors, umbilical cord blood units, and partially matched related donors has dramatically extended the availability of allogeneic transplantation. Transplant-related mortality has decreased due to improved supportive care, including better strategies to prevent severe infections and with the incorporation of reduced-intensity conditioning protocols that lowered the toxicity and allowed for transplantation in older patients. However, disease relapse and graft-versus-host disease remain the two major causes of mortality with unsatisfactory progress. Intense research aiming to improve adoptive immunotherapy and increase graft-versus-leukemia response while decreasing graft-versus-host response might bring the next breakthrough in allogeneic transplantation. Strategies of graft manipulation, tumor-associated antigen vaccinations, monoclonal antibodies, and adoptive cellular immunotherapy have already proved clinically efficient. In the following years, allogeneic transplantation is likely to become more complex, more individualized, and more efficient.http://rmmj.org.il/Pages/ArticleHTM.aspx?manuId=444Adoptive immunotherapyalternative donorconditioninggraft-versus-host diseasegraft-versus-leukemiahematopoietic stem cell transplantation |
| spellingShingle | Israel Henig Tsila Zuckerman Hematopoietic Stem Cell Transplantation—50 Years of Evolution and Future Perspectives Rambam Maimonides Medical Journal Adoptive immunotherapy alternative donor conditioning graft-versus-host disease graft-versus-leukemia hematopoietic stem cell transplantation |
| title | Hematopoietic Stem Cell Transplantation—50 Years of Evolution and Future Perspectives |
| title_full | Hematopoietic Stem Cell Transplantation—50 Years of Evolution and Future Perspectives |
| title_fullStr | Hematopoietic Stem Cell Transplantation—50 Years of Evolution and Future Perspectives |
| title_full_unstemmed | Hematopoietic Stem Cell Transplantation—50 Years of Evolution and Future Perspectives |
| title_short | Hematopoietic Stem Cell Transplantation—50 Years of Evolution and Future Perspectives |
| title_sort | hematopoietic stem cell transplantation 50 years of evolution and future perspectives |
| topic | Adoptive immunotherapy alternative donor conditioning graft-versus-host disease graft-versus-leukemia hematopoietic stem cell transplantation |
| url | http://rmmj.org.il/Pages/ArticleHTM.aspx?manuId=444 |
| work_keys_str_mv | AT israelhenig hematopoieticstemcelltransplantation50yearsofevolutionandfutureperspectives AT tsilazuckerman hematopoieticstemcelltransplantation50yearsofevolutionandfutureperspectives |