Stem Cells Transplant As A Treatment
The transplantation of hematopoietic stem cells is today really established as a
therapy for various types of congenital or other acquired severe disorders of the hematopoietic system as well as for chemo or radiosensitive malignancies. It includes autologous and allogeneic transplants of hematopoietic stem cells from bone marrow, peripheral blood or cord blood. Donors for allogeneic transplants can be HLA identical siblings, other family members or typed unrelated volunteer donors. All have their respective place, their advantages or disadvantages.
Over the last decade, hematopoietic stem cells transplant has really experienced an enormous increase in activity, and it has come as no surprise to see stem cell banks and cord blood banks growing in number and being used more and more often for stem cell storage or cord blood storage.
Standardization of the procedure has led to an expansion to most university hospitals and larger clinics throughout Europe. Convincing results and reduction in transplant related deaths have opened up new indications and increased patient age a lot.
Numbers have continuously increased, stem cell source has been expanded and indications have been added. During the same time, hematopoietic stem cells transplant has been assessed and compared to other different therapies and several controlled studies have been introduced.
This rapid development of hematopoietic stem cells transplant has certainly not remained unchallenged. Major concerns have been issued concerning the value of autologous hematopoietic stem cells transplant in solid tumors, especially in breast cancer patients. The issue remains open at this time. Still, for the first time since the introduction of different surveys, annual numbers of hematopoietic stem cells transplant have decreased in absolute terms. In contrast, more patients have been treated than ever before on controlled studies.
Numbers of patients treated with allogeneic hematopoietic stem cells transplant increased for most main indications, but not for all to the same extent. Fewer transplants than in nineteen ninety eight were actually performed the year after. For autologous hematopoietic stem cells transplant, an increase was observed in acute myeloid leukemia and other diseases. A decrease was observed mainly for breast cancer with nearly seven hundred transplants less in ninety eight, for the other solid tumors, the leukemia and the non-Hodgkins lymphomas. It is interesting to note that disease categories with fewer transplants in ninety nine had in principle a high coefficient of variation.
There is an emerging trend for allogeneic hematopoietic stem cells transplant in myeloma and non-Hodgkins lymphoma, explaining the large coefficient of variation and the marked increase in transplants.
by: wayne hasede
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