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Knochenmarktransplantation: Unterschied zwischen den Versionen

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'''Knochenmark-Transplantation''' ist die herkömmliche bzw. umgangssprachliche Bezeichnung für die [[Transplantation]] von blutbildenden Bestandteilen des [[Knochenmark]]s. Dabei werden [[Stammzelle]]n von einer Spenderperson auf eine geschädigte Person übertragen. Das wurde zum Beispiel nach der [[Katastrophe von Tschernobyl]] an den akut von der Strahlung betroffenen Feuerwehrleuten vorgenommen - allerdings erfolglos, sie verstarben dennoch. Weitere Einzelheiten dazu finden sich weiter unten in diesem Artikel.
'''Knochenmark-Transplantation''' ist die herkömmliche bzw. umgangssprachliche Bezeichnung für die [[Transplantation]] von blutbildenden Bestandteilen des [[Knochenmark]]s. Dabei werden [[Stammzelle]]n von einer Spenderperson auf eine geschädigte Person übertragen. Das wurde zum Beispiel nach der [[Katastrophe von Tschernobyl]] an den akut von der Strahlung betroffenen Feuerwehrleuten vorgenommen - allerdings erfolglos, sie verstarben dennoch.  
 
{| class="wikitable" |
| bgcolor="#dfdfdf" | '''Freie Übersichtsartikel'''
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| bgcolor="#dfdfdf" | '''Wichtige Übersichtsartikel'''
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| bgcolor="#dfdfdf" | '''Medline Suchterm/ Synonyme'''
| align="left" width="800"|
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| bgcolor="#00dfdf" | '''Was ist das'''
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| bgcolor="#dfdfdf" | '''Struktur'''
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| bgcolor="#dfdfdf" | '''Physiologie'''
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| bgcolor="#dfdfdf" | '''Knockout'''
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| bgcolor="#dfdfdf" | '''Transgen'''
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| bgcolor="#dfdfdf" | '''Mutation'''
| align="left" width="800"|
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| bgcolor="#dfdfdf" | '''Polymorphismus'''
| align="left" width="800"|
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| bgcolor="#dfdfdf" | '''Genexpression'''
| align="left" width="800"|
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| bgcolor="#dfdfdf" | '''Inhibitoren'''
| align="left" width="800"|
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| bgcolor="#dfdfdf" | '''Agonisten'''
| align="left" width="800"|
|}


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Hematology Am Soc Hematol Educ Program ():392-421 (2002) PMID 12446434 </ref><ref name="PMID11722995">Preventing opportunistic infections after hematopoietic stem cell transplantation: the Centers for Disease Control and Prevention, Infectious Diseases Society of America, and American Society for Blood and Marrow Transplantation Practice Guidelines and beyond. Hematology Am Soc Hematol Educ Program ():392-421 (2001) PMID 11722995 </ref><ref name="PMID11722994">Non-myeloablative transplants for malignant disease. Hematology Am Soc Hematol Educ Program ():375-91 (2001) PMID 11722994 </ref><ref name="PMID9932627">Allogeneic peripheral blood stem cell transplantation as an alternative to allogeneic bone marrow transplantation. Intern Med 37(12):1001-2 (1998) PMID 9932627 </ref><ref name="PMID8835602">Late onset bone marrow transplant nephropathy. 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== Orientierung ==
== Orientierung ==
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* [http://www.knochenmark.de Deutsche Stammzellspender Datei]
* [http://www.knochenmark.de Deutsche Stammzellspender Datei]
* [http://www.rhoen-klinikum-ag.com/rka/cms/dkd_2/deu/51105.html Stiftung Deutsche Klinik für Diagnostik GmbH, Wiesbaden (Fachabteilung Knochenmarktransplantation)]
* [http://www.rhoen-klinikum-ag.com/rka/cms/dkd_2/deu/51105.html Stiftung Deutsche Klinik für Diagnostik GmbH, Wiesbaden (Fachabteilung Knochenmarktransplantation)]
== Einzelnachweise ==
<references />


{{PPA-Silber}}
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Version vom 2. Februar 2019, 06:25 Uhr

Knochenmark-Transplantation ist die herkömmliche bzw. umgangssprachliche Bezeichnung für die Transplantation von blutbildenden Bestandteilen des Knochenmarks. Dabei werden Stammzellen von einer Spenderperson auf eine geschädigte Person übertragen. Das wurde zum Beispiel nach der Katastrophe von Tschernobyl an den akut von der Strahlung betroffenen Feuerwehrleuten vorgenommen - allerdings erfolglos, sie verstarben dennoch.

Freie Übersichtsartikel[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][94][95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][110][111][112][113][114][115][116][117][118][119][120][121][122][123][124][125][126][127][128][129][130][131][132][133][134][135][136][137][138][139][140][141][142][143][144][145][146][147][148][149][150][151][152][153][154][155][156][157][158][159][160]

Orientierung

Mit der Knochenmarktransplantation wird das Organ, welches das Blut und seine Bestandteile, also die Erythrozyten, die Blutplättchen, Blutkörperchen wie die Leukozyten und die Lymphozyten sowie mesenchymale Stammzellen bildet, durch Fremdmaterial eines artgleichen Spenders (allogen) ersetzt. Dies nachdem es geschädigt wurde (z. B. unfallbedingte Verstrahlung), eine nicht überlebbare Schädigung zu erwarten ist (Hochdosis-Chemotherapie) oder es aus anderen Gründen ersetzt werden muß (einige vererbte sog. Speicherkrankheiten, bei welchen einzelne Enzyme fehlen, die im neuen Knochenmark und dessen Abkömmlingen gebildet werden können). Ebenso gibt es Therapiekonzepte, bei denen autologes, d. h. empfängereigenes, Knochenmark hoch gereinigt wird und nach z. B. einer Chemotherapie zurückgegeben wird. Dieses Verfahren nennt man autologe Stammzellentransplantation.

Behandlung des Spenders und des gespendeten Materials

Spenderauswahl

Die Menschen besitzen auf den Immunzellen Moleküle, die kleingeschnittene Molekülfragmente von "Antigenen" präsentieren, sog. HLA (human leukocyte antigen) oder allgemein MHC (major histocompatibility complex) genannt, von denen es verschiedene Einzelgene mit jeweils sehr vielen unterschiedlichen Formen gibt. Präsentiert ein nicht-eigenes HLA ein gegebenes Antigenfragment, so wird diesees vielleicht etwas gedreht gehalten und dann 'falsch' erkannt mit der Folge, daß das Immunsystem paranoid reagiert und es zu Autoaggressionerscheinungen kommt indem entweder das transplantierte Knochenmark zerstört wird, oder die neuen Immunzellen des gespendeten Marks sich gegen den Patienten richten (GvH Reaktion).

Aus diesem Grunde muß eine weitgehende Gleichheit der HLA Moleküle zwischen Spender und Empfänger vorliegen - aus biologischen und pharmakologischen Gründen viel weitergehend als z. B. bei der Lebertransplantation.

Laborchemisch werden die Immunzellen 'typisiert', d. h. es wird bestimmt, welche HLA Eigenschaften vorliegen. Alle möglichen Spender eines organisatorischen Raumes (z. B. Deutschland, z. B. Eurotransplant-Gebiet) werden in einer Datenbank gespeichert. Liegt Bedarf vor, so wird die Datenbank abgefragt und ein Spender ermittelt. Dieser kann der Nachbar des Patienten sein oder irgendwo auf der Welt leben.

Harvesting

Es gibt zwei Methoden, Knochenmarkzellen zu gewinnen:

  • Das Knochenmark selbst wird angebohrt und etwas davon entnommen
  • Periphere Stammzellen werden mittels Apheresetechniken (Bindung des CD34 Antigens an Affinitätssäulen) mit einem entfernt dialyseähnlichen Verfahren gewonnen.

Insbesondere beim zweiten Verfahren ist es sinnvoll, eine gesteigerte Bildung der zu gewinnenden Zellen durch Gabe eines pharmakologischen Stimulators der Blutbildung, z. B. dem Wachstumsfaktor G-CSF, hervorzurufen.

Risiken und Nebenwirkungen

Allergie und Schock auf die Analgesie und Kurznarkose, Infektion bis Osteomyelitis, Postpunktionsschmerzen; Thrombose und Embolie, Fettembolie.

Purging

Durch gabe selektiv toxischer Substanzen wird aus dem gewonnenen Gemisch das übrigbleiben, was zur Transplantation benötigt wird, nämlich die Stammzellen. Methodik:___

Empfängervorbereitung

Damit erstens Platz vorhanden ist, wo das Material anwachsen kann, zweitens die hemmenden Einflüsse des Normalen nicht stören können und drittens ggf potentiell schädliche Zellen welche sich im Knochenmark aufhalten (z. B. maligne Zellen bei der Hauptindikation Leukämie) entfernt werden, wird der Patient folgenden Prozeduren unterworfen:

TBI

Eine hochdosierte Strahlentherapie wird auf das Knochenmark, die Regionen in welchen die meisten Lymphknoten sitzen und auf die Milz zentriert, um das hämopoietische System des Empfängers zu zerstören.

Conditioning

Zwei Ziele werden mit der Verabreichung zytotoxischer Substanzen verfolgt: Zerstörung des Vorhandenen und Modulation der Empfänglichkeit des Markgebietes für neue Stammzellen. Im Rahmen autologer Stammzellgewinnung auch Mobilisierung derselben.

Verwendete Substanzen:

  • Cyclophosphamid
  • Busulfan
  • Melphalan
  • Thiotepa

Manchmal ist es nicht notwendig, das ganze Knochenmark auszulöschen. Therapiekonzepte heißen dann

  • non-ablative BMT
  • mini-allograft
  • reduced-intensity-preparative-regimen

Ganz ohne Konditionierung die

  • donor leukocyte infusion

Spezifische Therapie

Krebserkrankungen (typischerweise Leukämien, Lymphome und Myelome) werden einer extrem toxischen Chemotherapie unterzogen, welche als Kollateralschaden das Blutbildungssystem zerstört. Die Durchführung einer Knochenmarktransplantation bei nichthämatopoietischen (d. h. soliden Tumoren, z. B. Neuroblastom) zum Zwecke des Gebrauchs höher toxischer Chemotherapien wird bei einzelnen Entitäten eingesetzt.

Immunsuppression

Neben den laborchemisch bestimmbaren wird es weitere Polymorphismen im Immunsystem geben, die zu Autoaggressionreaktionen führen werden. Aus diesem Grunde müssen die Patienten dauerhaft mit sog. Immunsuppressiva (z. B. Ciclosporin und Steroiden) behandelt werden.

Komplikationen

Die kurzfristige Mortalität der KMT liegt bei 15%, d. h. einer von 7 Patienten stirbt an der Anwendung dieses Verfahrens, nicht an den Folgen der zu behandelnden Grunderkrankung.

Infektionen

Insbsondere: Zytomegalie (CMV-Virus: Pneumonie, Retinopathie, Gastroenteritis); andere Herpesviren (HHV-6, EBV), opportunistische Erreger wie Pneumocystis carinii (PCP-Pneumonie) und Pilzinfektionen (systemische Mycosen) sind Folgen des insbesondere in der Frühphase völlig funktionslosen Immunabwehrsystems.

Harnblasenentzündung

Durch Adenoviren oder Polyomaviren sowie toxisch durch den Cyclophosphamid-Metaboliten Acrolein.

GvH Disease

Das neue Immunsystem erkennt den Empfängerorganismus als "fremd" und greift diesen an.

HvG Disease

Abstoßungsreaktion, ist das Transplantat zerstört hat der Pateint keine Überlebenschance.

Engraftment Syndrom und organspezifische Manifestationen

Durch das biologische Durcheinander im Rahmen eines SIRS (systemic inflammatory response syndrome) werden irgendwelche Botenstoffe gebildet (diverse Zytokine, Interleukine, Interferone usw.), welche die Endothelzellen (Gefäßinnenseitendeckzellen) der kleinen und großen Blutgefäße aktivieren. Dadurch schwellen diese an, die Gewebe werden schlechter mit Blut versorgt, gehen zugrunde und wirken toxisch auf den Organismus. Begleitend eine Blugerinnungsstörung /DIC = disseminated intravascular coagulation mit Blutungen und Thrombosen und ein Schockzustand.

  • Engraftment Syndrom : div. Systeme
  • Thrombotic thrombpcytopenic Purpura: Mikroangiopathie - Mikrothrombosen in verschiedenen Organen
  • Hepatic venoocclusive disease : Leber, Venenthrombose
  • BOOP bronchiolitis obliteration organizing pneumonia: Lunge, Verschluß der kleinsten Atemwege
  • Diffuse alveolar haemorrhage : Lunge, Einblutung

Posttransplantation lymphoproliferative disorder

Autologe Stammzellentransplantation

Es werden Stammzellen des Patienten gewonnen, aufbewahrt und dann gegeben, wenn durch eine geplante Behandlung das Knochenmark erheblich geschädigt worden ist, z. B. im Rahmen einer Hochdosischemotherapie von soliden Tumoren. Die oben beschriebenen Konzepte von Harvesting, Konditionierung und Therapie bilden ein Kontinuum, wenn zur 'Mobilization' der Stammzellen besondere Cytostatika wie Cyclophosphamid eingesetzt werden und wenn mit der Chemotherapie der Organismus 'konditioniert' wird - es werden mit einem Minimum an extrem toxischen Substanzen ein Maximum an notwendigen und gezielten Wirkungen erreicht.

Behandelbare Krankheiten

Hämatologisch neoplastische Erkrankungen

  • AML akute myeloische Leukämie, ist häufigste Indikation
  • ALL akute lymphoblastische Leukämie
  • andere Leukämien
  • Multiples Myelom (autologe SCT); POEMS-Syndrom; M.Waldenström
  • Hodgkin Lymphom
  • Non Hodgkin Lymphome, Mantle-cell-Lymphoma
  • Myelodysplastisches Syndrom
  • Aplastische Anämie

Solide neoplastische Erkrankungen

  • Neuroblastom
  • Medulloblastom
  • Ewing Sarkom
  • Wilms Tumor

Hämopoietische Erbkrankheiten und Immundefizienzsyndrome und mesenchymale Abkömmlinge

  • Thalassämie (fehlfunktionierendes Hämoglobin)
  • Shwachman Diamond Syndrom
  • SCID severe combined immuno-deficiency
  • Diamond Blackfan Anämie
  • Fanconi Anämie
  • Chediak Higashi Syndrom
  • Wiskott Aldrich Syndrom
  • Porphyrie: cong. erythropoietic porphyria
  • Red blood cell Pyruvate kinase deficiency
  • Osteopetrose
  • Evans Syndrom
  • Glanzmann Thrombasthenie
  • Leukocyte Adhesion deficiency
  • Congenital dyserythropoietic anemia
  • DiGeorge Syndrom
  • Familial amegakaryocytic Thrombocytopenia
  • Familial hemo/erythropoietic Lymphohistiocytosis
  • Hereditäre Sphärozytose
  • Dyskeratosis congenita
  • Hyper Immunoglobulin M Syndrom
  • Chronic granulomatous Disease = Septische Granulomatose

Andere Erbkrankheiten bei welchen ein systemisch verfügbarer Enzymersatz angestrebt wird und gentechnologischer Enzymersatz noch nicht verfügbar ist.

Im wesentlichen sind dies sog. 'Speicherkrankheiten', bei welchen jeweils ein charakteristisches Enzym der Lysosomen fehlt. Lysosomen sind Organellen, welche diverse Substanzen abbauen. Fehlt ein Enzym, so 'speichern' die Lysosomen die nicht abbaubaren Moleküle, sie werden sehr groß und es resultieren jeweils unterschiedliche Krankheitsbilder. Lysosomale Enzyme sind sehr einfach zu ersetzen, da sie aus dem Extrazellulärraum aufgenommen werden und in Vakuolen zu den Lysosomen transportiert werden. Als Quelle der zu ersetzenden Enzyme dienen Abkömmlinge der transplantierten Knochemnarksstammzellen.

  • Mucopolysaccharidosen
  • Farber Disease - infantile Ceramidase deficiency
  • Metachromatische Leukodystrophy
  • Globoid cell Leukodystrophy
  • Niemann Pick Disease

Autoimmunerkrankungen und Amyloidosen

  • AL-Amyloidose (Erkrankung der B-Lymphozyten)
  • Hypereosinophiles Syndrom
  • Shulman s Syndrom
  • Systemischer Lupus Erythematodes

Mir völlig unbekannte Erkrankungen - ehrlich gesagt auch viele darüber

  • Wolman disease
  • Griscelli Syndrom
  • Alexander s Disease

Besondere Konzepte

  • BMT vom Zwilling
  • BMT haploidentisch vom Geschwister
  • Nabelschnurblut-Transplantation
  • Tandem Transplantation
  • Nicht-myeloablative Transplantation
  • Donor leukocyte Infusion
  • Graft versus Leukemia- Effekt
  • Mixed chimerism

Ausblick: Regenerative Medizin

Idealerweise autologe Stammzellen ganz früher Natur (ESC= embryonal stemm cells), dem Knochenmark abgeleitete Stammzellen (mesenchymal stem cell, Fibrocyte, Endothelvorläuferzellen) mit variabler Organotropie, orthotope organspezifische Stammzellen usw. in der Intention, Gleiches durch Gleiches zu ersetzen oder das Einbringen gewebsuntypischer Zellen zur Veränderung des Gewebsverhaltens (Beeinflussung von Tumoren z. B. durch embryonale Gewebe)sowie die pharmakologische Beeinflussung der Gewebeeigenschaften z. B. durch Modulation lokaler Wachstumsinhibitoren (neuronal-axonale Regeneration nach Querschnittslähmung) sind die Therapieformen, welche meine Generation noch einsetzen wird.

Bibliographie

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  39. ↑ Treatment of severe veno-occlusive disease with defibrotide: compassionate use results in response without significant toxicity in a high-risk population. Blood 92(3):737-44 (1998) PMID 9680339
  40. ↑ Malignancies after hematopoietic stem cell transplantation: many questions, some answers. Blood 91(6):1833-44 (1998) PMID 9490664
  41. ↑ Placental and/or umbilical cord blood: an alternative source of hematopoietic stem cells for transplantation. Blood 90(12):4665-78 (1997) PMID 9389681
  42. ↑ Allogeneic blood stem cell transplantation: considerations for donors. Blood 90(3):903-8 (1997) PMID 9242518
  43. ↑ Autologous transplantation therapy for chronic myelogenous leukemia. Blood 89(8):2623-34 (1997) PMID 9108379
  44. ↑ The biology and clinical uses of blood stem cells. Blood 89(7):2233-58 (1997) PMID 9116266
  45. ↑ Treatment of hepatic venocclusive disease with recombinant human tissue plasminogen activator and heparin in 42 marrow transplant patients. Blood 89(5):1501-6 (1997) PMID 9057629
  46. ↑ Biologic and clinical effects of granulocyte colony-stimulating factor in normal individuals. Blood 88(8):2819-25 (1996) PMID 8874177
  47. ↑ Ex vivo expansion of hematopoietic precursors, progenitors, and stem cells: the next generation of cellular therapeutics. Blood 87(8):3082-8 (1996) PMID 8605320
  48. ↑ Late infections after allogeneic bone marrow transplantations: comparison of incidence in related and unrelated donor transplant recipients. Blood 86(10):3979-86 (1995) PMID 7579369
  49. ↑ Acute graft-versus-host disease: grade and outcome in patients with chronic myelogenous leukemia. Working Party Chronic Leukemia of the European Group for Blood and Marrow Transplantation. Blood 86(2):813-8 (1995) PMID 7606012
  50. ↑ Treatment of Chediak-Higashi syndrome by allogenic bone marrow transplantation: report of 10 cases. Blood 85(11):3328-33 (1995) PMID 7756666
  51. ↑ Bone marrow transplantation in major histocompatibility complex class II deficiency: a single-center study of 19 patients. Blood 85(2):580-7 (1995) PMID 7812013
  52. ↑ Peripheral blood stem cell transplants for multiple myeloma: identification of favorable variables for rapid engraftment in 225 patients. Blood 85(2):588-96 (1995) PMID 7529066
  53. ↑ Relationship between patterns of engraftment in peripheral blood and immune reconstitution after allogeneic bone marrow transplantation for (severe) combined immunodeficiency. Blood 84(11):3936-47 (1994) PMID 7949150
  54. ↑ A special report: bone marrow transplants using volunteer donors--recommendations and requirements for a standardized practice throughout the world--1994 update. The WMDA Executive Committee. Blood 84(9):2833-9 (1994) PMID 7949160
  55. ↑ Graft-versus-host disease: new directions for a persistent problem. Blood 84(7):2061-7 (1994) PMID 7919322
  56. ↑ Treatment and prevention of cytomegalovirus pneumonia after bone marrow transplantation: where do we stand? Blood 83(9):2392-8 (1994) PMID 8167329
  57. ↑ Hematopoietic recovery after 10-Gy acute total body radiation. Blood 83(2):596-9 (1994) PMID 8286754
  58. ↑ Graft-versus-leukemia: no longer an epiphenomenon. Blood 82(8):2273-7 (1993) PMID 8400279
  59. ↑ Preparative regimens for autologous bone marrow transplantation. Blood 81(2):277-80 (1993) PMID 8422454
  60. ↑ Conditioning for allogeneic marrow transplantation in patients with lymphohematopoietic malignancies without the use of total body irradiation. Blood 80(7):1648-58 (1992) PMID 1391935
  61. ↑ Bone marrow transplantation for thalassemia and other inherited disorders of hemoglobin. Blood 80(6):1379-81 (1992) PMID 1520865
  62. ↑ Determinants of engraftment after allogeneic marrow transplantation. Blood 79(7):1647-50 (1992) PMID 1558962
  63. ↑ Minor histocompatibility antigens. Blood 76(7):1269-80 (1990) PMID 2207305
  64. ↑ Indications for marrow transplantation in acute lymphoblastic leukemia. Blood 75(4):815-8 (1990) PMID 2405919
  65. ↑ Bone marrow transplantation in the treatment of patients with lymphoma. Blood 73(7):1749-58 (1989) PMID 2653463
  66. ↑ The kinetics of immune reconstitution after human marrow transplantation. Blood 69(2):369-80 (1987) PMID 3542077
  67. ↑ Allogenic bone marrow transplantation: current status and future directions. Blood 62(5):941-64 (1983) PMID 6354307
  68. ↑ Current status of bone marrow transplantation for aplastic anemia and acute leukemia. Blood 49(5):671-81 (1977) PMID 15688
  69. ↑ Experimental treatment of total-body irradiation injury: a brief review. Blood 12(8):746-54 (1957) PMID 13446002
  70. ↑ Blood and marrow stem cell transplants in autoimmune disease. A consensus report written on behalf of the European League Against Rheumatism (EULAR) and the European Group for Blood and Marrow Transplantation (EBMT). Br J Rheumatol 36(3):390-2 (1997) PMID 9133976
  71. ↑ Acute graft-versus-host disease after allogeneic bone marrow transplantation. Can Med Assoc J 129(9):969-74 (1983) PMID 6367917
  72. ↑ Editorial: Bone-marrow transplants for immunodeficiency syndromes. Can Med Assoc J 109(7):569 (1973) PMID 4147519
  73. ↑ Diffuse alveolar hemorrhage following allogeneic bone marrow transplantation in children. Chest 124(2):660-4 (2003) PMID 12907557
  74. ↑ Fiberoptic bronchoscopy in allogeneic bone marrow transplantation: findings in the era of serum cytomegalovirus antigen surveillance. Chest 120(4):1094-100 (2001) PMID 11591544
  75. ↑ Pulmonary complications of bone marrow transplantation. Chest 109(4):1066-77 (1996) PMID 8635332
  76. ↑ Pulmonary complications of bone marrow transplantation. Chest 87(2):237-46 (1985) PMID 2981658
  77. ↑ Spectrum of renal pathology in hematopoietic cell transplantation: a series of 20 patients and review of the literature. Clin J Am Soc Nephrol 2(5):1014-23 (2007) PMID 17702721
  78. ↑ Nephrotic syndrome after hematopoietic cell transplantation: do glomerular lesions represent renal graft-versus-host disease? Clin J Am Soc Nephrol 1(4):685-94 (2006) PMID 17699273
  79. ↑ Bronchiolitis obliterans following haematopoietic stem cell transplantation. Eur Respir J 29(5):1007-19 (2007) PMID 17470622
  80. ↑ Obliterative bronchiolitis in haematopoietic stem cell transplantation: can it be treated? Eur Respir J 25(3):402-4 (2005) PMID 15738280
  81. ↑ Reduced intensity conditioning before allografting: moderate enthusiasm may be more appropriate. Eur Respir J 23(3):357-8 (2004) PMID 15065819
  82. ↑ Unrelated donor stem cell transplantation in acquired severe aplastic anemia: a systematic review. Haematologica 94(12):1732-42 (2009) PMID 19648165
  83. ↑ Cord blood transplantation: state of the art. Haematologica 94(4):451-4 (2009) PMID 19336748
  84. ↑ Allogeneic stem cell transplantation for thalassemia major. Haematologica 93(12):1780-4 (2008) PMID 19050069
  85. ↑ Allogeneic transplantation in multiple myeloma. Haematologica 93(9):1295-300 (2008) PMID 18757850
  86. ↑ Hematopoietic stem cell mobilization. Haematologica 93(3):321-4 (2008) PMID 18310535
  87. ↑ Allogeneic transplantation in lymphoma: current status. Haematologica 92(11):1533-48 (2007) PMID 18024402
  88. ↑ Post-transplant lymphoproliferative disorders: from treatment to early detection and prevention? Haematologica 92(11):1447-50 (2007) PMID 18024391
  89. ↑ Current status of reduced-intensity-conditioning allogeneic stem cell transplantation for acute myeloid leukemia. Haematologica 92(4):533-41 (2007) PMID 17488664
  90. ↑ Spontaneous splenic rupture in a healthy allogeneic donor of peripheral-blood stem cell following the administration of granulocyte colony-stimulating factor (g-csf). A case report and review of the literature. Haematologica 91(5 Suppl):ECR08 (2006) PMID 16709516
  91. ↑ Strategies for widening the use of cord blood in hematopoietic stem cell transplantation. Haematologica 91(5):584-7 (2006) PMID 16670062
  92. ↑ Allogeneic hematopoietic stem cell transplantation for metastatic breast cancer. Haematologica 89(5):599-605 (2004) PMID 15136224
  93. ↑ Expansion of cord blood hematopoietic stem cells for clinical application. Haematologica 89(3):263 (2004) PMID 15020261
  94. ↑ Non-myeloablative conditioning before allogeneic stem cell transplantation in adult acute lymphoblastic leukemia. Haematologica 88(5):484-6 (2003) PMID 12745266
  95. ↑ Treatment of severe life-threatening graft-versus-host disease by autologous peripheral blood stem cell transplantation using a nonmyeloablative preconditioning regimen. Haematologica 88(3):ELT06 (2003) PMID 12651288
  96. ↑ Stem cell transplantation for patients with solid tumors. Haematologica 88(2):124-5 (2003) PMID 12604400
  97. ↑ Are we sure we all do the same things? Results from a GITMO survey on basic practices in allogeneic bone marrow transplantation. Haematologica 87(5):449-52 (2002) PMID 12010654
  98. ↑ Oupatient programs of myeloablative chemotherapy, autologous and allogeneic bone marrow transplantation. Haematologica 85(12):1233-4 (2000) PMID 11114127
  99. ↑ Low intensity regimens with allogeneic hematopoietic stem cell transplantation as treatment of hematologic neoplasia. Haematologica 85(3):304-13 (2000) PMID 10702821
  100. ↑ Allogeneic bone marrow transplantation for paroxysmal nocturnal hemoglobinuria. Haematologica 85(1):1-2 (2000) PMID 10627666
  101. ↑ Autologous and allogeneic transplantation with peripheral blood CD34+ cells: a pediatric experience. Haematologica 84(2):167-76 (1999) PMID 10091416
  102. ↑ Management of human cytomegalovirus infection and disease after allogeneic bone marrow transplantation. Haematologica 84(1):71-9 (1999) PMID 10091394
  103. ↑ Bone marrow transplantation for severe aplastic anemia from HLA identical siblings. Haematologica 84(1):2-4 (1999) PMID 10091385
  104. ↑ Allogeneic hematopoietic stem cell transplantation after immunosuppressive but non-myeloablative conditioning: "miniallografts" are no small matter. Haematologica 83(10):865-7 (1998) PMID 9830793
  105. ↑ Ex vivo expansion of hematopoietic cells and their clinical use. Haematologica 83(9):824-48 (1998) PMID 9825579
  106. ↑ Clinical use of allogeneic hematopoietic stem cells from sources other than bone marrow. Haematologica 83(2):159-82 (1998) PMID 9549928
  107. ↑ The veno-occlusive disease of the liver. Haematologica 82(6):718-25 (1997) PMID 9499675
  108. ↑ Allogeneic hematopoietic stem cells from sources other than bone marrow: biological and technical aspects. Haematologica 82(2):220-38 (1997) PMID 9175330
  109. ↑ Stem cells and stem cell transplantation. Haematologica 81(6):573-87 (1996) PMID 9009446
  110. ↑ Peripheral blood stem cell transplantation for the treatment of multiple myeloma: biological and clinical implications. Haematologica 81(4):356-75 (1996) PMID 8870384
  111. ↑ CD34-positive cells: biology and clinical relevance. Haematologica 80(4):367-87 (1995) PMID 7590508
  112. ↑ ASH evidence-based guidelines: is there a role for second allogeneic transplant after relapse? Hematology Am Soc Hematol Educ Program ():414-8 (2009) PMID 20008227
  113. ↑ Recognizing and managing chronic graft-versus-host disease. Hematology Am Soc Hematol Educ Program ():134-41 (2008) PMID 19074071
  114. ↑ Late pulmonary, cardiovascular, and renal complications after hematopoietic stem cell transplantation and recommended screening practices. Hematology Am Soc Hematol Educ Program ():125-33 (2008) PMID 19074070
  115. ↑ Follicular NHL: from antibodies and vaccines to graft-versus-lymphoma effects. Hematology Am Soc Hematol Educ Program ():226-32 (2007) PMID 18024634
  116. ↑ Diagnosis, genetics, and management of inherited bone marrow failure syndromes. Hematology Am Soc Hematol Educ Program ():29-39 (2007) PMID 18024606
  117. ↑ Vaccine-enhanced donor lymphocyte infusion (veDLI). Hematology Am Soc Hematol Educ Program ():486-91, 513 (2006) PMID 17124103
  118. ↑ Reduced-intensity regimens in allogeneic hematopoietic stem cell transplantation for hemoglobinopathies. Hematology Am Soc Hematol Educ Program ():398-401 (2006) PMID 17124089
  119. ↑ Reduced-intensity regimens in allogeneic stem-cell transplantation for non-hodgkin lymphoma and chronic lymphocytic leukemia. Hematology Am Soc Hematol Educ Program ():390-7 (2006) PMID 17124088
  120. ↑ Managing the patient with chronic myeloid leukemia through and after allogeneic stem cell transplantation. Hematology Am Soc Hematol Educ Program ():226-32 (2006) PMID 17124065
  121. ↑ Stem cell transplantation (cord blood transplants). Hematology Am Soc Hematol Educ Program ():354-71 (2004) PMID 15561692
  122. ↑ Marrow failure. Hematology Am Soc Hematol Educ Program ():318-36 (2004) PMID 15561690
  123. ↑ The hematologist and radiation casualties. Hematology Am Soc Hematol Educ Program ():473-96 (2003) PMID 14633795
  124. ↑ Stem cell mobilization. Hematology Am Soc Hematol Educ Program ():419-37 (2003) PMID 14633793
  125. ↑ Realistic prospects for stem cell therapeutics. Hematology Am Soc Hematol Educ Program ():398-418 (2003) PMID 14633792
  126. ↑ Hematopoietic cell transplantation for benign hematological disorders and solid tumors. Hematology Am Soc Hematol Educ Program ():372-97 (2003) PMID 14633791
  127. ↑ New developments in allotransplant immunology. Hematology Am Soc Hematol Educ Program ():350-71 (2003) PMID 14633790
  128. ↑ Stem cell transplantation: supportive care and long-term complications. Hematology Am Soc Hematol Educ Program ():422-44 (2002) PMID 12446435
  129. ↑ Non-myeloablative transplantation. Hematology Am Soc Hematol Educ Program ():392-421 (2002) PMID 12446434
  130. ↑ Preventing opportunistic infections after hematopoietic stem cell transplantation: the Centers for Disease Control and Prevention, Infectious Diseases Society of America, and American Society for Blood and Marrow Transplantation Practice Guidelines and beyond. Hematology Am Soc Hematol Educ Program ():392-421 (2001) PMID 11722995
  131. ↑ Non-myeloablative transplants for malignant disease. Hematology Am Soc Hematol Educ Program ():375-91 (2001) PMID 11722994
  132. ↑ Allogeneic peripheral blood stem cell transplantation as an alternative to allogeneic bone marrow transplantation. Intern Med 37(12):1001-2 (1998) PMID 9932627
  133. ↑ Late onset bone marrow transplant nephropathy. Intern Med 35(6):489-93 (1996) PMID 8835602
  134. ↑ Treatment of refractory autoimmune diseases with lymphoablation and hematopoietic stem cell support. Isr Med Assoc J 4(11 Suppl):865-7 (2002) PMID 12455162
  135. ↑ Stem-cell transplantation for primary immunodeficiencies. Isr Med Assoc J 4(8):648-52 (2002) PMID 12183876
  136. ↑ Non-myeloablative stem-cell transplantation in the treatment of malignant and non-malignant disorders. Isr Med Assoc J 4(4):272-9 (2002) PMID 12001702
  137. ↑ Developments in hematopoietic stem-cell transplantation in the treatment of autoimmune diseases. Isr Med Assoc J 4(4):268-71 (2002) PMID 12001701
  138. ↑ Chronic kidney disease in long-term survivors of hematopoietic cell transplantation: epidemiology, pathogenesis, and treatment. J Am Soc Nephrol 17(7):1995-2005 (2006) PMID 16723390
  139. ↑ Bone marrow transplant nephropathy: a case report and review of the literature. J Am Soc Nephrol 8(1):166-73 (1997) PMID 9013462
  140. ↑ A review of the current status and techniques of allogeneic bone marrow transplantation for treatment of leukaemia. J Clin Pathol 36(11):1207-14 (1983) PMID 6355192
  141. ↑ Animal models for bone-marrow transplantation. J Med Genet 7(4):305-9 (1970) PMID 4396089
  142. ↑ Allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission: systematic review and meta-analysis of prospective clinical trials. JAMA 301(22):2349-61 (2009) PMID 19509382
  143. ↑ Clinical applications of blood-derived and marrow-derived stem cells for nonmalignant diseases. JAMA 299(8):925-36 (2008) PMID 18314435
  144. ↑ Biology of chronic graft-versus-host disease: implications for a future therapeutic approach. Keio J Med 57(4):177-83 (2008) PMID 19110529
  145. ↑ Hematopoietic cell transplantation for adult patients with myelodysplastic syndromes and myeloproliferative disorders. Mayo Clin Proc 78(8):981-90 (2003) PMID 12911046
  146. ↑ Hepatic veno-occlusive disease (sinusoidal obstruction syndrome) after hematopoietic stem cell transplantation. Mayo Clin Proc 78(5):589-98 (2003) PMID 12744547
  147. ↑ Post-allogeneic haematopoietic stem cell transplantation membranous nephropathy: clinical presentation, outcome and pathogenic aspects. Nephrol Dial Transplant 22(5):1369-76 (2007) PMID 17255123
  148. ↑ Comparison of renal injury in myeloablative autologous, myeloablative allogeneic and non-myeloablative allogeneic haematopoietic cell transplantation. Nephrol Dial Transplant 20(4):678-83 (2005) PMID 15741210
  149. ↑ Haemolytic uraemic syndrome following bone marrow transplantation. Case report and review of the literature. Nephrol Dial Transplant 11(7):1332-7 (1996) PMID 8672033
  150. ↑ Acute graft versus host disease. Orphanet J Rare Dis 2():35 (2007) PMID 17784964
  151. ↑ A staging system for infantile Krabbe disease to predict outcome after unrelated umbilical cord blood transplantation. Pediatrics 118(3):e879-89 (2006) PMID 16923928
  152. ↑ Diffuse alveolar hemorrhage in pediatric hematopoietic cell transplant patients. Pediatrics 109(5):965-71 (2002) PMID 11986464
  153. ↑ Non-infectious pulmonary complications after bone marrow transplantation. Postgrad Med J 78(919):257-62 (2002) PMID 12151565
  154. ↑ Autologous haematopoeitic stem cell rescue (AHSCR) for severe rheumatic disease in children: guidance for BSPAR members--executive summary. Rheumatology (Oxford) 45(12):1570-1 (2006) PMID 17077155
  155. ↑ Allogeneic haematopoietic stem cell transplantation with reduced intensity conditioning regimens ("minitransplants"). Swiss Med Wkly 131(5-6):59-64 (2001) PMID 11383226
  156. ↑ Bone marrow transplantation and the lung. Thorax 41(7):497-502 (1986) PMID 3538482
  157. ↑ Bone marrow transplantation. Part II--autologous. West J Med 152(1):46-51 (1990) PMID 2408234
  158. ↑ Bone marrow transplantation. Part I--Allogeneic. West J Med 151(6):638-43 (1989) PMID 2694621
  159. ↑ Bone marrow transplantation. West J Med 151(6):658-9 (1989) PMID 2487998
  160. ↑ Acute renal failure in the setting of bone marrow transplantation. Kidney Int 46(5):1443-58 (1994) PMID 7853806

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