Allogene Blutstammzelltransplantation – ein Überblick

Zusammenfassung

Die allogene Blutstammzell- oder Knochenmarktransplantation ist eine effektive kurative Therapieoption für chemotherapierefraktäre oder rezidivierte hämatologische Neoplasien wie Leukämien und Lymphome. Nach einer Vorbehandlung mittels Chemotherapie mit oder ohne Ganzkörperbestrahlung werden Spenderzellen zur Rekonstitution der Hämatopoese verabreicht. Diese Spenderzellen üben einen über den Effekt von Chemotherapie hinausgehenden Immuneffekt zur Kontrolle oder Eradikation der Grunderkrankung aus. Einhergehend mit diesem sog. Transplantat-versus-Tumor-Effekt (graft-versus-tumor effect, GvT) tritt häufig eine akute und/oder chronische Transplantat-gegen-Wirt-Erkrankung auf (graft-versus-host disease, GvHD), die substanziell die Mortalität und Morbidität nach Transplantation mitbestimmt. Die Balance zwischen GvHD und GvT mittels verschiedener Parameter wie Spenderauswahl, Stammzellquelle, Konditionierung, Immunerholung und Immunsuppression stellt die Herausforderung für die allogene Stammzelltransplantation dar.

Abstract

Allogeneic haematopoietic stem cell transplantation is an effective treatment option for chemotherapy-refractory or relapsed haematological malignancies such as leukaemias and lymphomas. After conditioning with chemotherapy with or without total body irradiation, donor cells are infused to reconstitute haematopoiesis. Donor-derived immune cells induce immune reactions to control or eradicate the underlying disease, thereby going beyond the effect of chemotherapy. This graft-versus-tumour effect (GvT) is often accompanied by detrimental graft-versus-host reactions (graft-versus-host disease, GvHD), which substantially influence the mortality and morbidity after transplantation. The balance between GvHD and GvT, implementing various parameters such as donor selection, stem cell source, conditioning, immune reconstitution and immunosuppressive regimens, represents the challenge in the field of allogeneic stem cell transplantation.

Schlüsselwörter

allogene Blutstammzelltransplantation - Graft-versus-Host-Erkrankung - Graft-versus-Tumor-Effekt

Key words

allogeneic haematopoietic stem cell transplantation - graft-versus-host disease - graft-versus-tumour effect

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