New therapeutic modalities on hematopoietic stem cell transplantation / 대한내과학회지

ABSTRACT

Hematopoietic stem cell transplantation (HSCT) has been used to treat a variety of non-malignant and malignant lymphohematopoietic disease. But, there are many obstacles in performing HSCT for patients who do not have a human leukocyte antigen (HLA)-matched donor or are not eligible for HSCT because of old age and comorbidities. A better understanding of transplantation biology led to the development of non-myeloablative stem cell transplantation, HLA-haploidentical stem cell and umbilical cord blood (UCB) transplantation. Non-myeloablative stem cell transplantation is being commonly used in older patients as well as in disorders due to their safety and therapeutic effect. For patients without a matched HLA-identical sibling or unrelated donor, other graft sources, such as UCB and HLA-haploidentical donors, have been used. Transplantation using UCB is used in child transplantation, but it is not always suitable for adult transplantation because of insufficient cell doses. Transplantation of the stem cells from HLA-haploidentical donors emerges as an alternative source for acute leukemia patients without matched donors, but it is faced with the difficulties of graft rejection, GVHD and delayed immune reconstitution. It is necessary to overcome these difficulties through further studies.