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Hematopoietic stem cell transplantation in the new millennium: report from City of Hope National Medical Center.

Progress in the in the field of human stem cell transplantation (HSCT) has led to a reduction in transplant-related toxicities and an improvement in survival rates. In the allogeneic setting, conditioning regimens containing FTBI and high dose VP-16 produce high rates of long-term progression-free survival in patients with AML and ALL. Because of more rapid engraftment, peripheral blood stem cells are increasingly being used for allogeneic HSCT, however, longer follow-up will be required to determine whether there are differences in overall survival and long-term complications such as chronic graft-versus host disease (GVHD). Results of autologous transplantation for acute leukemias are improving as new strategies are used to decrease the risk of relapse. For diffuse aggressive NHL, high-dose therapy and autologous HSCT has been established as a potentially curative therapy when performed at the time of relapse or as part of the frontline treatment in selected patients with poor prognostic features at presentation. Patients with HIV-associated NHL may also benefit from autologous HSCT. In other subtypes of NHL such as mantle cell lymphoma and low-grade lymphoma, the curative potential of autologous transplantation is less certain and the graft-versus-lymphoma effect which can be seen in allogeneic HSCT may be required for cure of these histologic subtypes. Our current research efforts focus on reducing the risk of relapse as well as acute and long-term complications.