STEM-CELL TRANSPLANTATION - PAST, PRESENT AND FUTURE

Attempted human allogeneic marrow transplants in the 1950s and 60s wer e largely unsuccessful. In the past two decades the probability of suc cess has improved steadily depending on the type and stage of disease. Cure rates range from about 90% for nonmalignant diseases transplante d early to 15% for patients with advanced leukemia. Most marrow transp lants have involved an HLA matched sibling donor but, more recently, t hrough the National Marrow Donor Program, a matched unrelated voluntee r marrow donor can be found for many patients without a family donor. Current research involves new preparative regimens for elimination of malignant cells, better prevention of graft-versus-host disease, and t he use of hematopoietic growth factors and cytokines. Autologous trans plants, which use the patient's own marrow, are increasing. The hemat opoietic stem cell, which is responsible for marrow regeneration after a transplant, has been isolated and characterized. Stem cells for tra nsplantation can now be obtained from the peripheral blood after mobil ization of these cells by chemotherapy or hematopoietic growth factors . A variety of technological advances makes it possible to perform tra nsplants with less time in the hospital and a corresponding saving in cost.