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Hämatopoetische Stammzelltransplantation

Indikationen, Grundlagen und Ausblick

Hematopoietic stem cell transplantation. Indications, foundations and perspective

  • Schwerpunkt: Transplantationsmedizin
  • Published:
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Zusammenfassung

Die hämatopoetische Stammzelltransplantion (SCT) gehört heute zur Standardbehandlung von angeborenen und erworbenen Erkrankungen des Knochenmarks und Immunsystems. Während die autologe SCT v. a. in der Primärbehandlung des multiplen Myeloms und in der Rezidivbehandlung maligner Lymphome eingesetzt wird, liegt die Domäne der allogenen SCT in der Therapie von akuten Leukämien. Bei der Auswahl der Patienten für eine solche allogene SCT spielen krankheitsspezifische wie auch patientenspezifische Faktoren eine Rolle. So können wir sowohl bei der akuten myeloischen als auch bei der akuten lymphatischen Leukämie Risikofaktoren identifizieren, die ein schlechtes Therapieergebnis mit alleiniger Chemotherapie prognostizieren. Bei solchen Risikoleukämien kann durch eine Transplantation die Heilungsrate von 0–20% auf 30–60% angehoben werden. Neuere Verfahren der Konditionierung vor der Transplantation erlauben heute eine Transplantation bis zum Alter von 70 Jahren. Im höheren Lebensalter wird aber die Erfassung von Komorbiditäten besonders wichtig, um die transplantationsassoziierte Morbidität und Mortalität niedrig zu halten. Die zunehmende Zahl an Langzeitüberlebern nach Transplantation erfordert die Kenntnis der möglichen organspezifischen Spättoxizitäten inkl. Zweitneoplasien.

Abstract

The hematopoietic stem cell transplantation (HSCT) has become a standard therapy for many inherited and acquired disorders of the bone marrow and immune system. Autologous HSCT is mainly done as part of the primary therapy in multiple myeloma and as part of relapse therapy in malignant lymphoma. In contrast, allogeneic HSCT is predominantly performed in patients with acute leukemias. The selection process for allogeneic HSCT takes disease-specific as well as patient-specific factors into account. Risk factors which can predict for poor response to chemotherapy can now be identified in acute myeloid as well as lymphoid leukemia, based on phenotype, cytogenetics, molecular genetics and response to therapy. In these patients allogeneic HSCT can improve overall survival from 0–20% to 30–60%. New conditioning protocols have now raised the upper age limit for transplantation to 70 years. In elderly patients the selection of patients based on absence of comorbidities becomes especially important. The increasing number of long-term survivors requires knowledge of organ-specific late toxicities including secondary malignancies.

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  1. Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland

    S. Buchholz &  A. Ganser

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  1. S. Buchholz
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  2. A. Ganser
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Correspondence to A. Ganser.

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Buchholz, S., Ganser, A. Hämatopoetische Stammzelltransplantation. Internist 50, 572–580 (2009). https://doi.org/10.1007/s00108-008-2273-y

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