[Autologous transplantation of hematopoietic stem cells--therapeutic spectrum and future developments].
Autologous transplantation with haematopoietic blood stem cells (ASTx) is increasingly performed in blood cell disorders, in solid tumours and recently, in severe autoimmune disorders. In acute leukaemia, ASTx is usually offered to patients in complete remission who lack an HLA-identical donor. The chances and risks must be weighed against a transplant from a matched, unrelated donor. ASTx are routinely performed in aggressive lymphoma. Indications for ASTx in intermediate and low grade lymphoma await results of clinical trials. In Hodgkin's disease and myeloma, ASTx are routinely performed in first or subsequent remission, and in early stages, respectively. Among solid cancers, ASTx is an established part of the therapeutic measures in germ cell tumours. Patients with breast cancer may undergo ASTx in an adjuvant setting after complete tumour resection or in a palliative setting after progression. Initial enthusiasm has switched to a more awaiting view of this indication. Severe autoimmune disorders may undergo haemolymphatic ablation from conditioning and a stem cell transplant. The scientific evaluation of this approach should employ three sequential steps: The first step should employ vigorous immunosuppression followed by ASTx; the second step should employ stem cell autografts depleted from autoreactive immune cells; the third step should employ allogeneic stem cells from normal donors. A truly curative approach after complete haemolymphatic reconstitution is conceivable.
Hinterberger
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2. Medizinische Abteilung des Donauspitals im SMZ-Ost der Stadt Wien, Langobardenstrasse 122, A-1220 Wien. Wolfgang.Hinterberger@smz.magwien.gv.at
D000741:Anemia, Aplastic / Q000628:therapy; D001327:Autoimmune Diseases / Q000628:therapy; D001804:Blood Transfusion, Autologous; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007938:Leukemia / Q000628:therapy; D008223:Lymphoma / Q000628:therapy; D009369:Neoplasms / Q000628:therapy; D016896:Treatment Outcome