Hematopoietic stem cell transplantation: indications, types of transplantations, 132 donor selection

   Hematopoietic stem cell transplantation is a technology for the treatment of a wide range of oncological, hematological and a number of congenital diseases.

   The history of the use of bone marrow for medicinal purposes dates back more than 120 years.

   In 1891, 2 French doctors - Charles Brown-Séquard and Jacques D'Arsonval - gave the patient oral bone marrow to treat leukemias, naturally, without success. Approximately 50 years later, the first mention of intraosseous and intravenous injections of the bone marrow substrate appeared. Even then, a hypothesis was formulated that the patient's own immune system does not allow engraftment of donor cells. A very important discovery was made by Egon Lorenz in 1951, when it was first demonstrated that after irradiating mice with ionizing radiation and injecting them with bone marrow from other mice from the same litter, new bone marrow could take root and function. Naturally, it was difficult to prove the donor affiliation of a new hematopoiesis in the absence of knowledge about specific genetic markers, but the logic of the assumptions was built correctly.

   For the first time in modern history, bone marrow was transplanted to a patient by Edward Thomas at the Fred Hutchinson Cancer Research Center (USA) in 1957, and in 1958 Jean Dosset presented data on the existence of a human leukocyte antigen system (HLA system), which formed the basis further development of technology.

   The beginning of the modern era of transplantation is considered to be 1968, when Robert Good at the University Hospital of Minnesota (USA) performed the first bone marrow transplantation in a boy with primary immunodeficiency after selecting a related donor based on HLA typing data.

   Improving knowledge and development of new technologies in the field of genetics and cell engineering, combined with progress in the development of the latest, including targeted, drugs, are currently an argument for fundamentally new views on hematopoietic stem cell transplantation. Cell technologies are actively developing, certain successes have been achieved in the field of gene therapy. All this allows us to take a fresh look at some complex diseases, giving an objective chance for recovery to previously incurable patients.

   Now in the Russian Federation, hematopoietic stem cell transplantation is carried out in 8 transplant centers. In addition, construction is underway and it is planned to open at least 5 new regional clinics, in the structure of which transplantation activity is also planned.

   One of the fundamental differences between hematopoietic stem cell transplantation and many other medical technologies is the need for a long period of observation and treatment, a significant part of which should be carried out on an outpatient basis at the place of residence. Most of the problems that arise with patients at this stage can be solved by hematologists, oncologists, pediatricians or other specialists. However, in order to effectively identify and make timely and correct decisions, the doctor
often there is a lack of knowledge about the features of the technology and purely post-transplant clinical problems that need to be addressed.

   In this issue of the journal, we begin the column "School of Transplantation and Cellular Therapy". Here we plan to introduce you to transplantation, from the basics of technology to the analysis of certain topical clinical issues. FROM Taking into account the existing development vector of this method, we will also pay special attention to the modern view of cell therapy in the treatment of certain diseases, as well as a number of conditions where this technology already has a competitive advantage over pharmacotherapy. We very much hope that the information that we plan to share will be useful for a wide range of specialists.

   The first issue of the rubric is devoted to introductory issues of hematopoietic stem cell transplantation. We will talk about the indications, touch on the problem of histocompatibility and dwell on the fundamental issues of choosing the optimal pair donor-recipient.