Stem Cell Transplantation for Hematologic Malignancies
http://www.100md.com
《新英格兰医药杂志》
Hematopoietic stem-cell transplantation has become an essential component of the treatment of a variety of diseases during the past several decades. The procedure can cure patients with potentially fatal cancers, bone marrow disease, hereditary disorders of metabolism, and severe congenital immunodeficiencies. Since 1957, when E. Donnall Thomas and his colleagues issued their first report of stem-cell transplantation, a stream of outstanding advances has led to remarkable improvements in clinical results. Advances in the management of complications, immunosuppression, and T-cell depletion of the graft have overcome some of the barriers against successful stem-cell transplantation that were once considered insurmountable.
(Figure)
Hepatic Veno-Occlusive Disease in a Stem-Cell Transplant Recipient.
Courtesy of Howard Shulman, M.D.
Today, we can successfully transplant marrow from a related or unrelated donor, even if the marrow has HLA mismatches with the recipient, and we can use peripheral blood and umbilical-cord blood as alternative sources of stem cells. Consequently, indications for stem-cell transplantation have been widened considerably, thereby increasing dramatically the number of transplant recipients worldwide. An additional factor contributing to the increase in the indications for transplantation is the use of nonmyeloablative conditioning regimens. Transplantation after reduced-intensity conditioning, so-called mini-transplantation, decreases treatment-related toxic effects while preserving the immune-mediated graft-versus-tumor effect, thereby allowing transplantation in patients who are ineligible for conventional allografting because of age or underlying medical problems.
This multiauthored book is a comprehensive review of the current state of the art in hematopoietic stem-cell transplantation for hematologic cancers and breast cancer. The list of 37 authors includes renowned researchers and clinicians who are affiliated with outstanding North American institutions, and their experience is reflected in their contributions to the book. The 22 chapters are grouped into five parts, the totality of which gives a multidimensional view of hematopoietic stem-cell transplantation.
The first part concerns the indications and results of transplantation for acute leukemia, myelodysplasia, chronic myelogenous leukemia, Hodgkin's and non-Hodgkin's lymphomas, multiple myeloma, and breast cancer. It discusses the relative merits of transplantation and non–transplant-related approaches to these disorders. The second part covers a range of important transplantation-related complications, including the pathophysiology and clinical consequences of acute and chronic graft-versus-host disease, the delayed immune reconstitution that leads to infectious complications, post-transplantation lymphoproliferative disease associated with Epstein–Barr virus infection, and noninfectious damage to the lungs and liver. The last chapter of this section tackles the concept of health-related quality of life in patients after hematopoietic stem-cell transplantation.
In the third part of the book, four chapters review the most important issues related to sources of donor stem cells, in particular the advantages and disadvantages of peripheral-blood stem cells as compared with traditional bone marrow transplantation from siblings or HLA-matched unrelated donors. Alternative sources of hematopoietic stem cells, such as haploidentical marrow cells and cord-blood transplants, are covered in two chapters. In the fourth part, two additional chapters on graft engineering review the process of purging the stem-cell graft to eliminate contaminating tumor cells in autologous transplantation and T-cell depletion in the allogeneic setting to prevent graft-versus-host disease. Finally, the last part of the book contains two chapters with a timely overview of two approaches that take advantage of the graft-versus-tumor effect: donor lymphocyte infusions and nonmyeloablative transplantation.
All of the chapters are informative and contain carefully compiled, extensive lists of references. There is some unavoidable overlap in subject matter and variations in style, conciseness, and depth. More extensive focus could have been given to autologous stem-cell transplantation for myelodysplasia and to the problem of adenoviral infections. Nevertheless, the editor has achieved his stated goal of providing students, physicians, and other health care professionals with the latest information that is available in this field. This book belongs in every facility that performs hematopoietic stem-cell transplantation.
Miguel A. Sanz, M.D., Ph.D.
Hospital Universitario La Fe
46009 Valencia, Spain
msanz@uv.es(Contemporary Hematology.))
(Figure)
Hepatic Veno-Occlusive Disease in a Stem-Cell Transplant Recipient.
Courtesy of Howard Shulman, M.D.
Today, we can successfully transplant marrow from a related or unrelated donor, even if the marrow has HLA mismatches with the recipient, and we can use peripheral blood and umbilical-cord blood as alternative sources of stem cells. Consequently, indications for stem-cell transplantation have been widened considerably, thereby increasing dramatically the number of transplant recipients worldwide. An additional factor contributing to the increase in the indications for transplantation is the use of nonmyeloablative conditioning regimens. Transplantation after reduced-intensity conditioning, so-called mini-transplantation, decreases treatment-related toxic effects while preserving the immune-mediated graft-versus-tumor effect, thereby allowing transplantation in patients who are ineligible for conventional allografting because of age or underlying medical problems.
This multiauthored book is a comprehensive review of the current state of the art in hematopoietic stem-cell transplantation for hematologic cancers and breast cancer. The list of 37 authors includes renowned researchers and clinicians who are affiliated with outstanding North American institutions, and their experience is reflected in their contributions to the book. The 22 chapters are grouped into five parts, the totality of which gives a multidimensional view of hematopoietic stem-cell transplantation.
The first part concerns the indications and results of transplantation for acute leukemia, myelodysplasia, chronic myelogenous leukemia, Hodgkin's and non-Hodgkin's lymphomas, multiple myeloma, and breast cancer. It discusses the relative merits of transplantation and non–transplant-related approaches to these disorders. The second part covers a range of important transplantation-related complications, including the pathophysiology and clinical consequences of acute and chronic graft-versus-host disease, the delayed immune reconstitution that leads to infectious complications, post-transplantation lymphoproliferative disease associated with Epstein–Barr virus infection, and noninfectious damage to the lungs and liver. The last chapter of this section tackles the concept of health-related quality of life in patients after hematopoietic stem-cell transplantation.
In the third part of the book, four chapters review the most important issues related to sources of donor stem cells, in particular the advantages and disadvantages of peripheral-blood stem cells as compared with traditional bone marrow transplantation from siblings or HLA-matched unrelated donors. Alternative sources of hematopoietic stem cells, such as haploidentical marrow cells and cord-blood transplants, are covered in two chapters. In the fourth part, two additional chapters on graft engineering review the process of purging the stem-cell graft to eliminate contaminating tumor cells in autologous transplantation and T-cell depletion in the allogeneic setting to prevent graft-versus-host disease. Finally, the last part of the book contains two chapters with a timely overview of two approaches that take advantage of the graft-versus-tumor effect: donor lymphocyte infusions and nonmyeloablative transplantation.
All of the chapters are informative and contain carefully compiled, extensive lists of references. There is some unavoidable overlap in subject matter and variations in style, conciseness, and depth. More extensive focus could have been given to autologous stem-cell transplantation for myelodysplasia and to the problem of adenoviral infections. Nevertheless, the editor has achieved his stated goal of providing students, physicians, and other health care professionals with the latest information that is available in this field. This book belongs in every facility that performs hematopoietic stem-cell transplantation.
Miguel A. Sanz, M.D., Ph.D.
Hospital Universitario La Fe
46009 Valencia, Spain
msanz@uv.es(Contemporary Hematology.))