Rafeah N T, Fadilah S A W
Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia.
Med J Malaysia. 2009 Mar;64(1):94-100; quiz 101.
Haematopoietic stem cell transplantation (HSCT) has progressed rapidly since its introduction about five decades ago. There is now an increasing demand for transplant physicians in both public and private domains to perform this procedure in view of significant improvement of remission rates in haematological malignancies and increasing indications of HSCT. Peripheral blood has largely replaced bone marrow as the preferred source of haematopoietic stem cells (HSC). Transplantation-related mortality and morbidity rates have considerably decreased because of improved conditioning regimens, human leukocyte antigen (HLA) typing methods, supportive care, and most importantly, prophylaxis, diagnosis and treatment of serious infections. New transplantation strategies, such as reduced intensity transplantation, have extended the use of allogeneic transplant to patients with older age and co-morbidities. Current efforts are focused on ways to increase the donor pool and to improve the long term outcome of HSCT survivors in particular to reduce the relapse rate and the late effects of HSCT. This article summarizes the sources and procurement of HSC, the types and process of HSCT, indications for HSCT and complications associated with HSCT with particular reference to the current practice within the local settings.
造血干细胞移植（HSCT）自大约五十年前问世以来发展迅速。鉴于血液系统恶性肿瘤缓解率的显著提高以及HSCT适应症的增加，现在公共和私营领域对移植医生进行该手术的需求日益增长。外周血已在很大程度上取代骨髓成为造血干细胞（HSC）的首选来源。由于预处理方案、人类白细胞抗原（HLA）分型方法、支持治疗的改进，以及最重要的是严重感染的预防、诊断和治疗，移植相关的死亡率和发病率已大幅下降。新的移植策略，如减低强度移植，已将异基因移植的应用扩展到老年和有合并症的患者。当前的努力集中在增加供体库的方法以及改善HSCT幸存者的长期结局，特别是降低复发率和HSCT的晚期效应。本文总结了HSC的来源和采集、HSCT的类型和过程、HSCT的适应症以及与HSCT相关的并发症，并特别参考了当地环境中的当前实践。
