Robert J Soiffer

During the past 25 years, hematopoietic stem cell transplantation (HSCT) has become accepted as routine treatment for many patients with hematologic malignancies. Traditionally, the primary biologic objectives of HSCT for malignant disease and marrow disorders include the following:

• Delivery of chemotherapy/radiotherapy sufficient to destroy tumor cells

• Infusion of a source of hematopoietic stem cells to replace damaged lymphoid or myeloid progenitors

• Establishment of organ graft tolerance to prevent rejection of donor cells

• Induction of graft-versus-tumor (GVT) activity by allo-geneic immune effector cells

Recent laboratory and clinical observations on the biology of transplantation have challenged many of the fundamental beliefs and practices established over the past quarter century. Insights into graft-versus-host disease (GVHD), graft-versus-leukemia (GVL) activity, stem cell engraftment, donor selection, minimal residual disease (MRD), infectious complications, and treatment-related organ dysfunction all have contributed to revisions and refinements in the current approach to potential transplant recipients.

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