Stem Cell Transplantation for Treatment of Malignancy

Allogeneic hematopoietic stem-cell transplantation involves infusion of pluripotent hematopoietic stem cells from a normal donor, which engraft and reconstitute hematopoiesis and immunity in the recipient. A preparative regimen involving chemotherapy and or radiation is given with a goal to eradicate the malignancy as well as to provide sufficient immunosuppression to prevent graft rejection. Infections may occur due to posttransplant immune deficiency, and donor immune cells can react against the recipient and produce graft-versus-host disease (GVHD). Allogeneic hematopoietic transplants can also confer an additional immunologic graft-versus-malignancy (GVM) effect, where donor immunocompetent cells can eradicate neoplastic cells that survive the chemo-radiotherapy preparative regimen. The major challenge in the field is to develop approaches to separate the benefit of GVM from the toxicity of GVHD, and to more rapidly complete immune reconstitution.