Stem Cell Transplantation
Craddock C., Chakraverty R.
© 2016, 2011, 2005 by JohnWiley & Sons Ltd. All rights reserved. Haemopoietic stem cell transplantation (SCT) represents an important and increasingly utilized curative therapy in haematological malignancies and has an emerging role in the management of patients with haemoglobinopathies and bone marrow failure. (Figure 1) Autologous transplantation remains an important treatment strategy in patients with myeloma and relapsed lymphoma. Disease relapse remains the major cause of treatment failure after autologous SCT. Improvements in supportive care and treatment of post-transplant complications, a greater availability of alternative donors and advances in tissue typing have simultaneously improved the number of patients eligible for allogeneic transplantation and transplant outcome. The realization that an immunologically mediated graft-versus-leukaemia effect makes a major contribution to the curative effect of an allograft has led to the development of reduced-intensity conditioning regimens, which have substantially reduced the morbidity and mortality of allografting. Advances in the identification of patients whose outcome with standard chemotherapy is likely to be poor coupled with an increased awareness of the impact of pre-transplant co-morbidities on patient outcome has aided patient selection. The major challenges in allogeneic SCT are now the design of strategies which can reduce the major causes of transplant toxicity-principally acute and chronic graft-versus-host disease- and disease relapse which now represents the major cause of treatment failure.