TRANSPLANTATION OF HEMATOPOIETIC PROGENITOR CELLS WITH EMPHASIS ON THE RESULTS IN CHILDREN

Attempted human allogeneic marrow transplants in the 1950's and 60's w ere largely unsuccessful. In the past two decades the probability of s uccess has improved steadily depending on the type and stage of diseas e. All marrow transplant teams have observed that the results for chil dren are better than for adults. Long-term survival and apparent cure rates range from about 90 percent for non-malignant diseases transplan ted early to 15 percent for patients with advanced leukemia. Most marr ow transplants have involved an HL-A matched sibling donor but, more r ecently, through the worldwide marrow donor registries a matched unrel ated volunteer marrow donor can be found for many patients without a f amily donor. Current research involves new preparative regimens for el imination of malignant cells, better prevention of graft-versus-host d isease (GVHD), and the use of hematopoietic growth factors and cytokin es. Autologous transplants, which use the patient's own marrow, are in creasing. The hematopoietic stem cell, which is responsible for marrow regeneration after a transplant, has been isolated and characterized. Stem cells for transplantation can now be obtained from the periphera l blood after mobilization of these cells by chemotherapy or hematopoi etic growth factors.