Hematopoietic cell transplantation

Hematopoietic cell transplantation (HCT), also known as bone marrow transplant, is a medical procedure in the field of hematology and oncology that involves transplantation of hematopoietic stem cells, usually derived from bone marrow, peripheral blood, or umbilical cord blood. It is most often performed for patients with certain cancers of the blood or bone marrow, such as multiple myeloma or leukemia.

History

The first HCT was performed by Dr. E. Donnall Thomas in the late 1950s. Thomas was later awarded the Nobel Prize in Physiology or Medicine in 1990 for his pioneering work in this field.

Types

There are two main types of HCT: autologous and allogeneic. In an autologous transplant, the patient's own hematopoietic stem cells are harvested before the administration of high-dose chemotherapy or radiation therapy. In an allogeneic transplant, the hematopoietic stem cells come from a donor. The donor's and recipient's HLA tissue type must be a close match to prevent graft-versus-host disease (GVHD).

Procedure

The procedure for HCT begins with the administration of high-dose chemotherapy or radiation therapy to the patient. This is followed by the infusion of the hematopoietic stem cells. The stem cells travel to the bone marrow, where they begin to produce new blood cells in a process known as engraftment.

Risks and Complications

HCT carries significant risks and complications, including infection, graft-versus-host disease (GVHD), organ damage, and death. The risk of complications can depend on many factors, including the type of disease being treated, the type of transplant, the patient's overall health, and the patient's age.

Future Directions

Research is ongoing to find ways to reduce the risks and improve the outcomes of HCT. This includes the development of new conditioning regimens, strategies to prevent and treat GVHD, and methods to improve engraftment and immune reconstitution.