[Allogeneic hematopoietic stem-cell transplantation for hematological malignancies]

Area of Science:

• Immunology
• Hematology
• Transplantation Medicine

Background:

• Allogeneic hematopoietic stem cell (HSC) transplantation is a curative approach for hematological malignancies.
• It relies on the immunological conflict between donor HSCs and the recipient to eradicate malignant cells.
• Advances in HSC sources (bone marrow, blood, cord blood) and HLA typing have led to improved transplantation techniques.

Purpose of the Study:

• To review the principles and advancements in allogeneic HSC transplantation.
• To discuss the immunological reactions, including graft-versus-host disease (GVHD) and graft rejection (HVG).
• To highlight the graft-versus-leukemia (GVL) or graft-versus-malignancy (GVM) effect and post-transplantation complications.

Main Methods:

• Review of current literature on allogeneic HSC transplantation.
• Analysis of immunological mechanisms, including GVHD, HVG, and GVL/GVM.
• Discussion of various conditioning regimens, HSC sources, and ex vivo graft manipulation techniques.

Main Results:

• Allogeneic HSC transplantation is indicated for acute and chronic leukemias, with variable outcomes.
• Other hematological diseases also benefit from this potentially curative, though toxic, treatment.
• Improvements in unrelated transplantations, peripheral HSCs, cord blood, non-myeloablative conditioning, and ex vivo graft manipulation have broadened indications.

Conclusions:

• Allogeneic HSC transplantation remains a crucial curative treatment for hematological malignancies.
• Ongoing advancements continue to expand its applicability and improve patient survival.
• The graft-versus-leukemia effect is a key component of cellular immunotherapy post-transplantation.