Bone marrow stromal damage after chemo/radiotherapy: Occurrence, consequences and possibilities of treatment

High dose chemotherapy (CT) followed by bone marrow transplant (BMT) is inc reasingly used for the treatment of both hematological and solid neoplasms, but an understanding of its late consequences on the marrow microenvironme nt is still only at its beginning. It is in fact known that marrow stroma i s damaged by high-dose cytotoxic therapy and by radiation exposure. However little is known on the extent of this damage and on the self-repair abilit y of the stroma. The damage of the stromal microenvironment affects the lon g-term stem cell engraftment and the maintenance of hemopoietic functions, Furthermore, marrow stroma also represents a progenitor compartment for end osteal osteoblasts, and therefore its damage implies alterations of bone me tabolism. Indeed, osteoporosis has recently been recognized as a consequenc e, of BMT, but only a few studies have been performed to establish the func tional status of the stromal compartment after treatment with cytotoxic dru gs with or without total body irradiation (TBI) and its role in post-BMT se quelae.