Allogeneic hematopoietic cell transplantation as t

Authors: Frédéric Baron Rainer Storb

Publish Date: 2004/07/29

Volume: 26, Issue: 1-2, Pages: 71-94

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Abstract

Allogeneic hematopoietic cell transplantation HCT was originally developed as a form of rescue from highdose chemoradiotherapy which is given both to eradicate malignancy and provide sufficient immunosuppression for allogeneic engraftment The first attempts of allogeneic HCT in humans met with little success However a better understanding of the complexities of the human leukocyte antigen HLA system has allowed selecting compatible sibling donors and the development of postgrafting immunosuppressive regimens has helped prevent serious graftversushost disease thereby changing the role of allogeneic HCT from a desperate therapeutic maneuver to a curative treatment modality for many patients with malignant hematological diseases In addition the establishment of large registries of HLAtyped volunteers has permitted finding suitable unrelated donors for many patients without family donors Further advances in the immunogenetics of HLA especially typing by molecular techniques have improved results after unrelated HCT which have begun resembling those obtained with HLAidentical sibling grafts at least in young patients Important advances have also been made in the prevention and treatment of infectious complications and in other areas of supportive care Since the late seventies it has been recognized that allogeneic immunocompetent cells transplanted with the stem cells or arising from them mediated therapeutic antitumor effects independent of the action of the highdose therapy termed graftversustumor GVT effects This has prompted the recent development of nonmyeloablative conditioning regimens for allogeneic HCT that have opened the way to include elderly patients and those with comorbid conditions Remaining challenges include further advances in the prevention and treatment of both severe graftversushost disease and infections Also progress in adoptive transfer of T cells with relative tumor specificity and diseasetargeted therapy with agents such as Imatinib Rituximab or radiolabeled monoclonal antibodies would make allogeneic HCT even more effectiveThis work was supported by grants CA78902 CA18029 CA15704 DK42716 and HL36444 of the National Institutes of Health Bethesda MD F Baron is a research assistant of the National Fund for Scientific Research FNRS Belgium and supported in part by postdoctoral grants from the Fulbright Commission

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