TRANSPLANT OF HEMATOPOIETIC STEM-CELLS IN CHILDHOOD - WHERE WE ARE AND WHERE WE ARE GOING

Over the past decade, relevant improvements and refinements have signi ficantly charged the indications, technique and results obtained with allogeneic transplantation of hematopoietic stem cells (HSC) in childh ood, In this review the most important innovations that have character ized the practice of HSC transplantation in childhood during this deca de will be discussed. We will analyze the clinical and biological adva ntages or disadvantages which characterize most typically HSC transpla ntation procedure in terms of the source of these cells (bone marrow, peripheral blood, placental blood). A fundamental turning point in the history of allogeneic transplantation of HSC is represented by the us e of placental blood, which was first employed in 1988, Autologous, pe ripheral blood progenitor cells are Increasingly being used as a sourc e of HSC following high-dose therapy for malignant disease, because of the ease of collection and the markedly faster kinetics of engraftmen t in comparison with bone marrow, In particular, over the past decade, due to the much faster recovery of all hematopoietic lineages in comp arison with bone marrow and due to the short duration of antibiotic th erapy and hospitalization, also in pediatric patients, autotransfusion of circulating hematopoietic progenitors is rapidly replacing autolog ous hone marrow transplantation after high-dose chemotherapy for lymph omas and solid tumors. On the contrary, due to concerns In pediatric p atients related to the use of hematopoietic growth factors In a health y donor, allograft of peripheral blood progenitor cells is not routine ly used. Since indications for allogeneic HSC transplantation that had already been well established in the recent past have been complement ed by others and a relevant number of disorders are no longer consider ed to be eligible for allograft, the evolution in the indications for allogeneic transplant of HSC in childhood will be discussed. Likewise, biotechnological, social and organizational refinements which have al lowed the greatest advances of allogeneic HSC transplantation in this decade will be analyzed, as well as some still open bioethical questio n regarding this procedure. (C)1998, Ferrata Storti Foundation.