ABSTRACT
In the second half of the XX century, the transplant of hemopoietic progenitors ceased to be a desperate treatment with a high incidence of complications implying a high mortality, and became a curative treatment for thousands of patients with hematological neoplasias and other diseases. Since then understanding of the hemopoietic stem cells has increased, peripheral blood has replaced bone marrow as a source of progenitors, cord blood has been established as a viable source of progenitors and the realisation of unrelated transplants is a reality for many patients. The improvement of conditioning regimes and the introduction of new non-myeloablative treatments have reduced relapses. The new diagnostic techniques and the new anti-microbial treatments have reduced infectious complications and their mortality. There has been an advance in knowledge in determining minimal residual disease and the anti-tumour effect of the lymphocytes of the donor, which has made it possible to widen the indications. Besides, new understanding of the immunobiology of the transplant has, on the one hand, improved the options for controlling one of the principal complications, the graft-versus-host disease, and, on the other, a better use is made of the immunotherapeutic effect of the transplant.
Subject(s)
Graft vs Host Disease/therapy , Graft vs Tumor Effect , Hematopoietic Stem Cell Transplantation , Transplantation Conditioning/methods , Adult , Age Factors , Aged , Animals , Bone Marrow Transplantation , Cord Blood Stem Cell Transplantation , Dogs , Forecasting , Graft vs Leukemia Effect , Hematologic Neoplasms/therapy , Hematopoietic Stem Cell Transplantation/adverse effects , Hematopoietic Stem Cell Transplantation/history , History, 19th Century , History, 20th Century , History, 21st Century , Humans , Leukemia/therapy , Middle Aged , Neoplasms/therapy , Peripheral Blood Stem Cell Transplantation , Postoperative Complications/prevention & control , Postoperative Complications/therapy , Rats , Spain , Transplantation Conditioning/adverse effects , Treatment Outcome , Whole-Body IrradiationABSTRACT
En la segunda mitad del siglo XX el trasplante de progenitores hemopoyéticos ha pasado de ser un tratamiento desesperado con una alta incidencia de complicaciones que implicaba una elevada mortalidad, a ser un tratamiento curativo para miles de pacientes con neoplasias hematológicas y otras enfermedades. Desde entonces se han ampliado los conocimientos sobre las células madre hemopoyéticas, la sangre periférica ha sustituido a la médula ósea como fuente de progenitores, la sangre de cordón se ha establecido como fuente viable de progenitores, la realización de trasplantes no emparentados es una realidad para muchos pacientes. La mejora en los regímenes de acondicionamiento y la introducción de los regímenes no mieloablativos han disminuido las recaídas. Las nuevas técnicas diagnósticas y los nuevos tratamientos antimicrobianos han disminuido las complicaciones infecciosas y su mortalidad. Se han desarrollado los conocimientos en determinación de enfermedad mínima residual y el efecto antitumoral de los linfocitos del donante lo que ha permitido ampliar las indicaciones. Además, los nuevos conocimientos en la inmunobiología del trasplante han mejorado por un lado las opciones de controlar una de las principales complicaciones como es la enfermedad injerto contra huésped, y por otro un mejor aprovechamiento del efecto inmunoterápico del trasplante
In the second half of the XX century, the transplant of hemopoietic progenitors ceased to be a desperate treatment with a high incidence of complications implying a high mortality, and became a curative treatment for thousands of patients with hematological neoplasias and other diseases. Since then understanding of the hemopoietic stem cells has increased, peripheral blood has replaced bone marrow as a source of progenitors, cord blood has been established as a viable source of progenitors and the realisation of unrelated transplants is a reality for many patients. The improvement of conditioning regimes and the introduction of new non-myeloablative treatments have reduced relapses. The new diagnostic techniques and the new anti-microbial treatments have reduced infectious complications and their mortality. There has been an advance in knowledge in determining minimal residual disease and the anti-tumour effect of the lymphocytes of the donor, which has made it possible to widen the indications. Besides, new understanding of the immunobiology of the transplant has, on the one hand, improved the options for controlling one of the principal complications, the graft-versus-host disease, and, on the other, a better use is made of the immunotherapeutic effect of the transplant
