Article (Scientific journals)
Allogeneic hematopoietic cell transplantation as treatment for hematological malignancies: a review.
Baron, Frédéric; Storb, Rainer
2004In Springer Seminars in Immunopathology, 26 (1-2), p. 71-94
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Keywords :
Animals; Clinical Trials as Topic; Dogs; Graft vs Host Disease/etiology; Graft vs Tumor Effect; HLA Antigens; Hematologic Neoplasms/immunology/therapy; Hematopoietic Stem Cell Transplantation/adverse effects/history; History, 20th Century; History, 21st Century; Humans; Transplantation Conditioning; Transplantation, Homologous
Abstract :
[en] Allogeneic hematopoietic cell transplantation (HCT) was originally developed as a form of rescue from high-dose 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 graft-versus-host 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 HLA-typed 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 HLA-identical 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 anti-tumor effects independent of the action of the high-dose therapy, termed graft-versus-tumor (GVT) effects. This has prompted the recent development of non-myeloablative 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 graft-versus-host disease and infections. Also, progress in adoptive transfer of T cells with relative tumor specificity and disease-targeted therapy with agents such as Imatinib, Rituximab or radiolabeled monoclonal antibodies would make allogeneic HCT even more effective.
Disciplines :
Hematology
Author, co-author :
Baron, Frédéric  ;  Université de Liège - ULiège > Département des sciences cliniques > GIGA-R : Hématologie - Département des sciences cliniques
Storb, Rainer
Language :
English
Title :
Allogeneic hematopoietic cell transplantation as treatment for hematological malignancies: a review.
Publication date :
2004
Journal title :
Springer Seminars in Immunopathology
ISSN :
0344-4325
eISSN :
1432-2196
Publisher :
Springer Verlag, Berlin, Germany
Volume :
26
Issue :
1-2
Pages :
71-94
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 18 September 2009

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