The evolving art of hematopoietic stem cell transplantation: translational research in post-transplant immune reconstitution and immunosuppression.
Allogeneic hematopoietic stem cell transplantation (SCT) offers the best chance for cure and/or long-term survival for a broad range of diseases, including many high-risk hematologic malignancies, bone marrow failure states and subsets of inherited metabolic diseases and hemoglobinopathies. Clinical advances in allogeneic SCT have resulted in dramatically improved clinical outcomes over the past two decades, resulting in a significant expansion of transplant utilization to many recipients who would previously have been excluded from consideration, including elderly recipients and individuals lacking matched sibling or unrelated donors. Despite these advances, significant clinical challenges remain, including delayed immune reconstitution and the frequent occurrence of acute and chronic graft-versus-host disease, especially in the unrelated donor transplant setting. Translational laboratory efforts, facilitated by technical advances in our ability to measure thymopoiesis and functional T cell subsets in humans, have resulted in an improved understanding of immune recovery and have provided novel insights that may lead to more rational and selective immunosuppression.
Adult Stem Cell Transplant Program, Department of Medicine, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, 33136, USA, kkomanduri@med.miami.edu.
Krishna V
KV
Komanduri
Eric D
ED
Wieder
Cara L
CL
Benjamin
Robert B
RB
Levy
D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D006086:Graft vs Host Disease / Q000209:etiology / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D007156:Immunologic Memory; D056747:Immunomodulation; D016130:Immunophenotyping; D007165:Immunosuppression Therapy; D008213:Lymphocyte Activation / Q000276:immunology; D038041:Lymphopoiesis / Q000502:physiology; D015398:Signal Transduction; D016176:T-Lymphocyte Subsets / Q000276:immunology / Q000378:metabolism; D013950:Thymus Gland / Q000502:physiology; D057170:Translational Research, Biomedical; D014181:Transplantation Immunology; D014184:Transplantation, Homologous; D016896:Treatment Outcome