Blood Stem Cell Transplantation

This text seeks to convey the extent and significance of a current development in hematopoietic stem cell transplantation. Some of the applications that stand to impact this field most significantly are based on recent advances in the biological sciences, as demonstrated by the chapters on gene therapy, on the detection of minimal residual disease using molecular techniques, and on the use of radioimmunoconjugates targeting lymphoma and leukemia-associated antigens. Others are the results of clinical observations, for example, the association between graft-versus-host- disease (GVHD) and durable remissions that have led to creative clinical experiments such as donor leukocyte infusions (DLI). Attempts to unravel the biological events that underlie the responses seen in patients with relapsed chronic myelogenous leukemia treated with DLI are likely to provide the basis for future refinements in this clinical approach. Hopefully, improved response rates and reduced toxicity will result. The power of the immunologic response in controlling malignant disease is underscored in the chapter on post-transplant immunotherapy.Advances in the supportive care of transplant patients, including the pretransplant identification of those at risk from pulmonary complications and the use of cytokines to speed engraftment, have reduced morbidity and mortality to such a degree that it is appropriate to consider high-dose therapy and stem cell reconstitution in patients with nonmalignant diseases. The impressive advances that have occurred in transplantation for thalassemia are described by pioneers in their area of investigation. The burgeoning field of transplantation for autoimmune disorders, including its immunobiologic basis and soon-to- be-realized clinical potential, is also summarized. Continued progress in the use of high-dose therapy with stem cell rescue for the treatment of pediatric tumors, which derives in part from improved supportive care, is also detailed.