Hematopoietic stem cell transplantation (HSCT) is a therapeutic procedure in which hematopoietic stem cells, the self-renewing cells that give rise to all blood and immune cell lineages, are infused to restore or replace a patient's hematopoietic and immune system. It is used to treat malignant disorders such as leu…
Hematopoietic stem cell transplantation (HSCT) is a therapeutic procedure in which hematopoietic stem cells, the self-renewing cells that give rise to all blood and immune cell lineages, are infused to restore or replace a patient's hematopoietic and immune system. It is used to treat malignant disorders such as leukemias and lymphomas, as well as bone marrow failure states, hemoglobinopathies, and certain immune and metabolic diseases. Transplants are classified by the source of the cells: autologous, using the patient's own previously collected stem cells, and allogeneic, using cells from a donor. Stem cells may be obtained from bone marrow, mobilized peripheral blood, or umbilical cord blood, and adequate collection sometimes requires agents that enhance mobilization of stem cells into the circulation. In allogeneic transplantation, compatibility between donor and recipient at the human leukocyte antigen (HLA) loci is a central determinant of outcome; degrees of HLA mismatch, including in unrelated donors, and the presence of donor-specific antibodies influence engraftment and complications. The procedure typically involves a conditioning regimen followed by infusion and a period of profound immunosuppression during which patients are vulnerable to infection. Major complications include graft-versus-host disease in allogeneic settings, graft failure, immune cytopenias, and opportunistic infections. HSCT integrates transplant immunology, hematology, and supportive care, with engraftment and immune reconstitution as key goals.
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