Special Care of Blood and Marrow Stem Transplant Patients

Abstract

Hematopoietic cell transplantation (HCT) has evolved into one of the most effective therapeutic modalities for the treatment of malignant, immunologic, and genetic disorders [1]. More than 100 years ago, practitioners unsuccessfully administered bone marrow by mouth to leukemia patients in an effort to correct hematologic abnormalities [2]. Investigators later utilized the parenteral route to transplant marrow, again without benefit to those with hematologic and malignant disorders [3–6]. Painstaking, preclinical scientific studies in the late 1940s set the stage for the triumph of HCT, beginning with the studies of Jacobson and colleagues [7] who noted that splenic shielding prevented otherwise lethal irradiation. Lorenz and associates [8] later reported that infusion of bone marrow or spleen cells also protected animals from the deleterious effects of total body irradiation (TBI). Finally, several investigators described an immunologic syndrome in which engrafted murine donor cells attacked host tissues, a phenomenon subsequently shown to be graft-versus-host disease (GVHD) [9–11]. The seminal experiments of Till and McCullough [12] demonstrated that hematopoietic repopulating cells, derived from a single implanted cell, were capable of extensive proliferation and could be re-transplanted into secondary recipients. These innovative and pivotal investigations were extended to outbred species such as dogs and included both allogeneic as well as autologous hematopoietic cells collected from the blood as well as bone marrow [13]. These preclinical studies laid the foundation for HCT, a modality subsequently extended to humans in the 1950s that included autologous as well as allogeneic transplants [14–16]. With the notable exception of syngeneic grafts, these early transplants were plagued by many problems [17, 18].