Breaking dogmata to help patients: non-myeloablative haematopoietic stem cell transplantation.
Various dogmata have been broken as a consequence of the evolution of knowledge in the area of allogeneic haematopoietic stem cell (HSC) transplantation. The following is now clear: for the successful engraftment of allogeneic HSC, bone marrow ablation of the recipient is not required; HSCs create their own space through graft-versus-host reactions; several malignancies can be eradicated by the graft-versus-tumour effect; HSC allografting can be conducted on an out-patient basis; HSC allografting can be done in aged or debilitated individuals; HSC allografting can be achieved without transfusion of blood products; and the costs of the allografting procedures can be substantially diminished. Despite the fact that HSC allografting with reduced intensity conditioning may be related to several disadvantages, such as mixed chimaerism and relapse of the malignancy, breaking these dogmata has resulted in availability of HSC allografting to a larger number of individuals worldwide, thus offering true curative therapeutic options to patients who otherwise would not qualify to be given these opportunities.
Clínica Ruiz de Puebla, Centro de Hematología y Medicina Interna, 8B Sur 3710, 72530, Puebla, Mexico. gruiz1@clinicaruiz.com
Guillermo J
GJ
Ruiz-Argüelles
David
D
Gómez-Almaguer
D000818:Animals; D001781:Blood Component Removal; D016913:Blood Component Transfusion / Q000191:economics; D001853:Bone Marrow / Q000187:drug effects / Q000276:immunology; D003363:Cost Control; D003906:Developing Countries; D016527:Drug Costs; D015774:Ganciclovir / Q000008:administration & dosage; D006086:Graft vs Host Disease / Q000517:prevention & control; D020544:Graft vs Leukemia Effect; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000191:economics / Q000639:trends; D006789:Host vs Graft Reaction; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007843:Latin America; D017710:Lymphocyte Transfusion; D008800:Mexico; D008954:Models, Biological; D018448:Models, Immunological; D019653:Myeloablative Agonists / Q000009:adverse effects / Q000191:economics / Q000494:pharmacology; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000191:economics / Q000379:methods* / Q000639:trends; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000276:immunology*
D016756:Immunoglobulins, Intravenous; D019653:Myeloablative Agonists; D015774:Ganciclovir