Advances in hematopoietic stem cells transplantation

Abstract

Within a global perspective, the number of autologous (auto) and allogeneic (allo) hematopoietic stem cells transplantations (HSCT) is seen to be continuously growing over time. There have been one million such worldwide transplants registered up to 2012. Systemic sclerosis is a new indication for auto-HSCT, and in a randomized trial this method was found superior to the reference standard. Peripheral blood is the most frequently used source of hematopoietic cells for both auto-HSCT and allo-HSCT, although so far there is no evidence of its advantage over bone marrow in terms of overall survival after allogeneic transplant. The number of allo-HSCTs with reduced intensity conditioning is also growing, which can thus be applied to elderly patients. On the other hand, myeloablative protocols with reduced toxicity have been also developed. The availability of unrelated transplants is increasing due to the growing number of registered volunteers. In parallel haploidentical transplants (haplo-HSCT) have become increasingly popular thanks to new immunosuppressive protocols that use cyclophosphamide post-transplantation.