KEMİK İLİĞİ TRANSPLANTASYONU Özel Sayısı
Cilt 10 / No: 1 - 2 / Ocak - Şubat 1997

PREFACE
Burhan Ferhanoğlu

KEMİK İLİĞİ TRANSPLANTASYONUNUN TARİHÇESİ
Yücel Tangün

KEMİK İLİĞİ TRANSPLANTASYON İMMÜNOLOJİSİ
Mahmut Çarin

KEMİK İLİĞİ NAKLİ YAPILACAK HASTAYA VERİCİ SEÇİLMESİNDE KARIŞIK LENFOSİT KÜLTÜR TESTİ VE GENOTİPLEMENİN UYUMU
Mehmet Gültekin, Filiz Aydın, Fatma Oğuz, Sarper Diler, Mahmut Çarin

ENGRAFTMAN YETERSİZLİĞİ
Teoman Soysal

GRAFT VERSUS HOST HASTALIĞI
Teoman Soysal

HEMATOPOETİK VE İMMÜN SİSTEMİN YENİDEN YAPILANMASI
Burhan Ferhanoğlu

TRANSPLANTASYONDA İMMÜN TOLERANS
Burhan Ferhanoğlu

HEMATOPOETİK KÖK HÜCRE NAKLİNDE “HAZIRLAMA” VE KEMOTERAPİLİ HAZIRLAMA REJİMLERİ
Zafer Başlar

KEMİK İLİĞİ TRANSPLANTASYONUNDA TÜM VÜCUT IŞINLAMASI (TEKNİK KAVRAMLAR VE KLİNİĞİ)
Ahmet Öber

KEMİK İLİĞİ TOPLANMASI
Zafer Başlar

ERİŞKİNLERDE KEMİK İLİĞİ TRANSPLANTASYON ENDİKASYONLARI VE KLİNİK SONUÇLARI
Deniz Sargın

KEMİK İLİĞİ TRANSPLANTASYONUNUN KOMPLİKASYONLARI
Akın Uysal

KEMİK İLİĞİ NAKLİ SIRASINDA İNFEKSİYONLAR
Hamdi Akan

GRAFT YETMEZLİĞİ
Günhan Gürman

AKUT GRAFT VERSUS HOST HASTALIĞI (AGVH)
Nahide Konuk

KRONİK GRAFT VERSUS HOST HASTALIĞI
Haluk Koç

KÖK HÜCRE TRANSPLANTASYONUNDAN SONRA ALTTA YATAN MALİGN HASTALIKLARIN NÜKSÜ
Osman İlhan

KARACİĞERİN VENOOKLÜZİF HASTALIĞI
Mühit Özcan

AKRABA DIŞI (UNRELATED) DONÖRDEN KEMİK İLİĞİ TRANSPLANTASYONU
Burhan Ferhanoğlu

OTOLOG KEMİK İLİĞİ TRANSPLANTASYONU (OKİT)
Atilla Yalçın

PERİFERİK KÖK HÜCRE TRANSPLANTASYONU
Teoman Soysal

UMBİLİKAL KORDON (GÖBEK KORDONU) KANI TRANSPLANTASYONU
Meral Beksaç

TÜRK KEMİK İLİĞİ NAKLİ KAYIT SİSTEMİ TOPLU SONUÇLARI (1996)
Tevfik Akoğlu, Tülin Budak-Alpdoğan



PREFACE
Burhan Ferhanoğlu

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 population).
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.
Autologous transplantation 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, in Ankara.
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.