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Komplikationen der allogenen Knochenmark- und Stammzelltransplantation

Complications after allogeneic bone marrow and stem cell transplantation

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Zusammenfassung

Seit den 1970er-Jahren werden zunehmend Knochenmark- und Stammzelltransplantationen (KMT) durchgeführt. Die therapieassoziierte Letalität hat sich dank verbesserter Transplantationstechniken und supportiver Therapien deutlich reduziert. Jedes Jahr erhalten etwa 50.000 Menschen weltweit Zellen eines Familien- oder Fremdspenders, zunehmend auch nicht komplett HLA-identische Stammzellen. Mit der steigenden Zahl an Langzeitüberlebenden werden verstärkt Folgekrankheiten sichtbar. Dieser Beitrag befasst sich im Wesentlichen mit den Spätkomplikationen der allogenen KMT. Trotz Heilung der malignen Grunderkrankung ist das Gesamtüberleben der transplantierten Patienten verkürzt. Ursachen sind therapieassoziierte Zweitneoplasien, Infektionen und Organdysfunktionen. Als besondere Risikofaktoren gelten eine Ganzkörperbestrahlung, eine chronische Graft-vs.-host-Erkrankung sowie die Behandlung im Kindesalter. Nachsorgeleitlinien wurden erstmals 2006 vorgestellt, 2011 erfolgte ein Update.

Abstract

Since the 1970s there has been an increase in the number of bone marrow and stem cell transplantations as well as a decrease in transplantation-associated fatalities due to improved transplantation techniques and supportive therapy. Annually nearly 50,000 transplantations are conducted worldwide with matched family grafts and matched or sometimes mismatched unrelated donor grafts. The number of long-term survivors is increasing and the late complications of this relatively aggressive therapy are now becoming apparent. This article is essentially concerned with the delayed complications of bone marrow and stem cell transplantations. Despite curing the malignant primary disease the total survival of transplantation patients is reduced. The main reasons are infection, organ dysfunction and therapy-associated secondary neoplasms. Among the high risk factors are total body irradiation, chronic graft versus host disease as well as treatment during childhood. Guidelines for the follow-up care of these long-term survivors were first published in 2006 and then updated in 2011.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. E. Wollmer und A. Neubauer geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Hämatologie, Onkologie, Immunologie, Zentrum Innere Medizin, Philipps-Universität Marburg und Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstr. 1, 35033, Marburg, Deutschland

    E. Wollmer &  A. Neubauer

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  1. E. Wollmer
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Wollmer, E., Neubauer, A. Komplikationen der allogenen Knochenmark- und Stammzelltransplantation. Internist 55, 547–561 (2014). https://doi.org/10.1007/s00108-013-3432-3

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