For years, considerable attention was devoted to just getting it right: figuring out how to do a transplantation as safely as possible and preventing acute complications during the first 100 days from unraveling the effort. Tremendous advances in transplantation practice have made this therapy safer and outcomes have improved. In recent years, attention has shifted increasingly to other important considerations.
Management of myelodysplastic syndrome has been disappointing for years. The mainstay approach was only supportive care. A malaise settled all around. Today there are new Food and Drug Administration cleared therapies, and novel agents are on the horizon. True progress has been small to date, but with the number of new therapies and new classes of agents undergoing study, the future is hopeful.
For decades transplantation clinicians have used age in decisions about candidacy for hematopoietic cell transplantation (HCT) It has often been joked that as transplanters have aged the “acceptable” age for HCT has increased. It has been assumed that age is a surrogate for likelihood for transplantation morbidity and mortality.
The American Society for Blood and Marrow Transplantation (ASBMT) has supported the conduct of a series of evidence-based reviews exploring the role of hematopoietic cell transplantation (HCT) in various hematologic disorders over the past several years. This abridged report summarizes the major findings of two recent reviews addressing the role of HCT in the management of acute lymphoblastic leukemia, one review in children, the other in adults.
The three prime ingredients of allogeneic hematopoietic cell transplantation (HCT) are conditioning regimen, graft, and posttransplantation supportive care. For decades, much of the research interest has focused on the latter two ingredients. Characterization of graft hematopoietic and immune constituents and manipulation of these elements have led to important insights, new knowledge, and improved outcomes.
The remarkable early success of G-CSF in effective stem cell mobilization was both surprising and fortuitous. Only years later do we have a good (yet still incomplete) idea of why and how it happens.
With so much success in controlling cytomegalovirus (CMV) disease, one feels almost ungrateful to furtively whisper that there is more yet to do. Still, there is the inconvenience and expense of intravenous regimens, there are toxicity issues with current regimens, and we still face late CMV disease, which is growing in frequency.
Try as hard as it can, the myelodysplastic bone marrow just cannot seem to meet the ordinary day-to-day needs for blood cells. Indeed, failure is destined no matter what we do. Then, when it seems as bad as it can get, it only gets worse: total marrow shutdown or change into leukemia. Effective therapy has been long overdue.
Autoimmune disease can be viewed as an insurrection by security forces charged with protecting us from lurking outside dangers. What ensues is either smoldering conflict to attrition or large-scale open warfare. Treatments have generally been disappointing. Autoimmune phenomena are sometimes consequences of both autologous and allogeneic hematopoietic cell transplantation (HCT). So, why would one consider treating autoimmune diseases with HCT?
The deadly consequences of cytomegalovirus (CMV) infection after hematopoietic stem cell transplantation (HSCT) are all too well known to those who trained in the 1980s or before. This was a time after transplantation when clinicians and patient alike were beginning to breathe a sigh of relief that the prospects for a successful outcome were bright. Such hopes were quickly dashed by rapid and relentless respiratory failure followed by death.