Bone Marrow Transplants for Blood Cancers in Sweden

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British Medical Bulletin Advance Access originally published online

on September 11, 2006

British Medical Bulletin 2006 77-78(1):23-36; doi:10.1093/bmb/ldl005

© The Author 2006. Published by Oxford University Press.

Allogeneic haematopoietic stem cell transplantation: current status

and future outlook

Johan Aschan

Center for Allogeneic Stem Cell Transplantation and Division of

Hematology, Department of Medicine, Karolinska Institutet,

Karolinska University Hospital Huddinge, Stockholm, Sweden

Allogeneic haematopoietic stem cell transplantation (allo-SCT) is an

established treatment of haematological malignancies and other

immunohaematopoietic disorders. The use of unrelated donors and cord

blood (CB) grafts has increased the possibilities of finding a

donor, and results are approaching those after sibling donor

transplants.

The use of peripheral blood stem cells (PBSCs), instead of bone

marrow, results in faster engraftment and increased risk of chronic

graft-versus-host disease (GVHD). High-dose myeloablative (MA)

conditioning is recently challenged by reduced-intensity

conditioning (RIC) for older patients and those with comorbidity.

Better diagnostic tools and novel anti-microbial drugs have reduced

morbidity and mortality from infections.

A major problem is disease relapse. Early detection of minimal

residual disease or recurrent recipient haematopoietic cells allows

early intervention with immunotherapy. Donor lymphocyte infusions

(DLIs) have not only an anti-leukemic effect but also an anti-tumor

effect against a variety of solid organ tumours. New indications

such as metastatic solid tumours are investigated.

Mesenchymal stem cells (MSC) may enhance engraftment and have

immunomodulatory effects.