İLİĞİ TRANSPLANTASYONU Özel Sayısı
Cilt 10 / No:
1 - 2 / Ocak - Şubat 1997
NAKLİ YAPILACAK HASTAYA VERİCİ SEÇİLMESİNDE KARIŞIK LENFOSİT KÜLTÜR TESTİ
VE GENOTİPLEMENİN UYUMU
Filiz Aydın, Fatma Oğuz, Sarper Diler, Mahmut Çarin
VE İMMÜN SİSTEMİN YENİDEN YAPILANMASI
KÖK HÜCRE NAKLİNDE HAZIRLAMA VE KEMOTERAPİLİ HAZIRLAMA REJİMLERİ
TRANSPLANTASYONUNDA TÜM VÜCUT IŞINLAMASI (TEKNİK KAVRAMLAR VE KLİNİĞİ)
KEMİK İLİĞİ TRANSPLANTASYON ENDİKASYONLARI VE KLİNİK SONUÇLARI
NAKLİ SIRASINDA İNFEKSİYONLAR
AKUT GRAFT VERSUS
HOST HASTALIĞI (AGVH)
VERSUS HOST HASTALIĞI
KÖK HÜCRE TRANSPLANTASYONUNDAN
SONRA ALTTA YATAN MALİGN HASTALIKLARIN NÜKSÜ
(UNRELATED) DONÖRDEN KEMİK İLİĞİ TRANSPLANTASYONU
İLİĞİ TRANSPLANTASYONU (OKİT)
(GÖBEK KORDONU) KANI TRANSPLANTASYONU
TÜRK KEMİK İLİĞİ
NAKLİ KAYIT SİSTEMİ TOPLU SONUÇLARI (1996)
Transplantation of hematopoietic
stem cell has become an established theraphy for a number of congenital
or acquired disorders of the hematopoietic system as well as for chemo-or
radiosensitive malignancies. By the end of 1990, about 40.000 bone marrow
transplants have been performed worldwide. In 1995, a total of 12.101 blood
or marrow transplants, performed in Europe by 343 teams from 31 countries,
were reported to the European Group for Blood and Marrow Transplantation
(EBMT). There were major differences between participating countries. The
absolute numbers of transplants per country differ widely and range from3.2
to 733.3 total transplants per ten million. The number of transplants per
ten million inhabitants in Israel is 579.391 in France, 200 in Germany,
133 in Greece and 16.1 in Turkey (with 92 transplants and 57.2 million
The most important factor
affecting the success of the transplantation is the HLAsystem. Lately advances
in molecular biology have revealed this region in DNA. In this issue, immunologic
parameters, mainly serological determination of HLA and polimerase chain
reaction sequence specific primer (PCR-SSP) determination of HLA-DR antigens
has been written briefly by Dr. Çarin and Dr. Gürtekin.
Graft rejection describes
the active destruction of transplanted hematopoetic cells by immunocompetent
cells of the recipient, which is also referred to as host-versus-graft
reaction. Graft-versus-host reaction describes the aggressive reaction
of immunocompetent cells of the graft to antigenic structures of the recipient
tissue. Immunological aspects of graft rejection and graft-versus-host
disease (GVHD) has been written by Dr. Soysal. Radio and chemotherapeutic
treatment preceding bone marrow transplantation leads to the destruction
of the cellular and humoral immunity of the graft recipient and therefore,
to a temporary severe immune deficiency. The development of GVHD is the
most relevant factor in the impairment of immune reconstitution. Transplantation
tolerance means long-term acceptance of the grafted tissue in the absence
of continuous immunosupression. Immune reconstitution and several aspects
of immune tolerance are discussed in the article by Dr. Ferhanoğlu.
Before bone marrow transplantation,
pretreatment, called conditioning is necessary. It has to be immunosupressive
and should "create space' for the graft. Conditioning should also completely
eradicate the malignant cell clone in malignant disorders. Total body irradiation
(TBI) has been summarized by Dr. Öber and chemoterapeutic conditioning
by Dr. Başlar. Dr. Başlar also describes the technique of bone marrow harvesting.
Indications and clinical
results of bone marrow transplantation (BMT) has been written by Dr. Sargın.
Side effects allogeneic
bone marrow transplantation results primarily from the myelototoxicity
of the conditioning therapy, immunological complications due to genetic
disparities and the biologic behavior of the underlying disease after transplantation.
Specific problems of BMT has been written by İbn-i Sina Hospital team (Drs.
Akan, Gürman, Özcan, Koç, İlhan, Konuk and Uysal).
An HLA-matched related donor
ise available for fewer than 35 % of potential recipients; for patients
without such donors, the use of unrelated donors and cord blood are alternative
sources of stem cells. Unrelated donor transplantation was written by Dr.
Ferhanoğlu and cord blood by Dr. Beksaç, whose team performed the first
cord blood transplantation in Turkey.
is based on the phenomenon that a steep dose-response relationship exists
in most tumors that are sensitive to radiotherapy and chemotherapy. Dose
escalation of most cytotoxic agents is frequently limited by bone marrow
toxicity. Potentially irreversible, therapy-related damage to the patient's
bone marrow can be avoided by removing and cryopreserving bone marrow stem
cells before exposing the patient to high-dose cytotoxic treatment. The
retransfusion of these cells following such therapy can lead to complete
reconstruction of bone marrow function. This topic was reviewed by Dr.
Yalçın, director of Bone Marrow Transplantation program of GATA hospital,
Beginning in the early 1950s,
investigators found that hematopoetic precursors normally circulate in
the blood. Since the mid 1980s, apheresis has been used routinely to collect
hematopoietic precursors from the peripheral blood. Advantages and disadvantages
of peripheral blood stem cell transplantation has been reviewed by Dr.
Soysal in detail.
And the history of developments
in bone marrow transplantation in the world and in our country has been
summarised briefly by Dr. Tangün.
As the head of Bone marrow
Transplantation Subcomitee of the Turkish Society of Haematology, Dr. Akoğlu
summarised the data of National Bone Marrow Transplant Registry.
This special issue of Klinik
Gelişim (Bone Marrow Transplant)was written to serve as resource for physicans,
general practitioners and the medical personnel involved in the BMT. The
information presented here is not sufficiently detailed to be the only
source of for information necessary for the implementation of BMT, but
references are provied to offer additional insight. I am indebted to my
coworkers for their support. I am particulary grateful for the advices
and support of Dr. Ulutin and Dr. Tangün.