Rifón J J
Servivio de Hematología y Area de Terapia Celular, Clínica Universitaria de Navarra, 31008 Pamplona, Spain.
An Sist Sanit Navar. 2006;29 Suppl 2:137-51.
In the second half of the XX century, the transplant of hemopoietic progenitors ceased to be a desperate treatment with a high incidence of complications implying a high mortality, and became a curative treatment for thousands of patients with hematological neoplasias and other diseases. Since then understanding of the hemopoietic stem cells has increased, peripheral blood has replaced bone marrow as a source of progenitors, cord blood has been established as a viable source of progenitors and the realisation of unrelated transplants is a reality for many patients. The improvement of conditioning regimes and the introduction of new non-myeloablative treatments have reduced relapses. The new diagnostic techniques and the new anti-microbial treatments have reduced infectious complications and their mortality. There has been an advance in knowledge in determining minimal residual disease and the anti-tumour effect of the lymphocytes of the donor, which has made it possible to widen the indications. Besides, new understanding of the immunobiology of the transplant has, on the one hand, improved the options for controlling one of the principal complications, the graft-versus-host disease, and, on the other, a better use is made of the immunotherapeutic effect of the transplant.
在20世纪后半叶，造血祖细胞移植不再是一种并发症发生率高、死亡率高的绝望治疗方法，而是成为了数千名血液系统肿瘤及其他疾病患者的治愈性治疗方法。从那时起，对造血干细胞的认识不断增加，外周血已取代骨髓成为祖细胞的来源，脐血已被确立为一种可行的祖细胞来源，无关供体移植对许多患者来说已成为现实。预处理方案的改进和新的非清髓性治疗方法的引入降低了复发率。新的诊断技术和新的抗菌治疗方法降低了感染并发症及其死亡率。在确定微小残留病和供体淋巴细胞的抗肿瘤作用方面的知识有了进展，这使得扩大适应症成为可能。此外，对移植免疫生物学的新认识，一方面改善了控制主要并发症之一移植物抗宿主病的选择，另一方面更好地利用了移植的免疫治疗效果。
