Is our current strategy in manipulating hemopoiesis in autologous transplantation correct?

Autologous hemopoietic stem cell rescue following high-dose chemoradiotherapy is increasingly used in the treatment of lymphohemopoietic malignancy and selected solid tumors. While encouraging disease control has been reported in acute leukemia, lymphoma, multiple myeloma and breast carcinoma, such an approach suffers from a number of limitations. This review addresses a number of issues that may lead to better stem cells for transplant: which stem cell rescue provides the most rapid hemopoietic reconstitution, how can we get sufficient high quality stem cells for transplant to ensure complete and sustained reconstitution, what are the predictors of rapid and sustained hemopoietic reconstitution, what impact on hemopoietic reconstitution purging and positive selection technology may have, and how can we abrogate the obligatory delay to blood count recovery.