Hematopoietic stem cell transplantation in nonmalignant diseases

Treatment of patients with nonmalignant hematopoietic diseases by marrow grafts from HLA identical family members has progressed to a point where event free survivals of 75-90% can be expected. For allografts to be successful, conditioning programs have been devised that provide both the immunosuppression and the marrow space required for the incoming grafts to be accepted. Despite graft versus host disease prevention with methotrexate and cyclosporine, the acute and chronic forms of this disease continue to pose problems for a minority of patients after transplant, and they may necessitate prolonged courses of immunosuppressive therapy. The transplant procedures required for patients with these nonmalignant hematopoietic diseases could be directly applied to patients with autoimmune diseases.