Blood

Abstract

The transplantation of stem cells from the bone marrow, peripheral blood or cord blood has become a clinical procedure since the 1980s and is now annually performed in ten thousands of patients in the autologous and allogeneic setting world-wide. Refinement of human leukocyte antigen typing as well as recent advances in immunosuppression, anti-infective prophylaxis and therapy as well in supportive care have much improved the outcome of patients with leukemia and lymphoma, aplastic anemia, as well as hereditary diseases of the hematopoietic system. This is still an experimental therapy and patient subgroups that profit most from hematopoietic stem cell transplantation need to be defined. Consideration and classification of co-morbidity indices as well as cytogenetic risk factors are pivotal for making decisions on transplantation modalities. Modern conditioning regimens allow balancing of allo-effects against malignant cells versus normal tissue even in elderly patients. Recent innovations in cellular therapy combine allogeneic stem cell transplantation with genetically engineered or specifically selected T cells and potentially natural killer (NK) cells.