PubMed · 9260048
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I Bernstein. 1997. Hematologic malignancies.. https://doi.org/10.1097/00062752-199704040-00001
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Allogeneic stem cell transplantation is able to cure many hematologic malignancies, through, at least partially, a graft versus disease effect of the donor's immune system transfer. However, the toxicity of this technique limits its use to selected patients. The aim of non-myeloablative stem cell transplantation is to reduce the toxicity of the conditioning regimen while allowing the engrafement of donor's stem cells and the immunological antitumoral activity of the donor's immune system. Several reports have already demonstrated the validity of this concept. This new multi-step therapeutic strategy is complex, raises many questions and deserves further studies to be fully applicable to a greater number of patients.
After fifty years of investigations into the use of pluripotent haematopoietic stem-cell transplantation for cancer therapy, this procedure has progressed from one that was thought to be plagued with insurmountable complications to a standard treatment for many haematological malignancies. How have these hurdles been overcome, and how can the therapy be expanded to include patients who are too old or medically infirm to tolerate conventional transplant approaches?
Genetic markers associated with hematologic malignancies such as acute promyelocytic leukemia (APL) can be detected with high sensitivity and specificity using the reverse-transcription polymerase chain reaction (RT-PCR). This procedure can be applied to monitor minimal residual disease. In patients with APL, RT-PCR is now being used to detect molecular relapse, and a strong association has been found between outcome and the treatment of molecular as opposed to hematologic relapse. In APL, results from PCR assays are also being used to guide therapy. Prognostic groups can be defined using molecular and clinical characteristics of the disease as well as patient characteristics. In the future, PCR monitoring strategies may be adapted to the risk of relapse of individual patients. Patients at high risk of relapse may be monitored much more rigorously than patients at low risk of relapse. Although RT-PCR is in routine use as a clinical tool, the lack of standardization of techniques in different laboratories has resulted in some difficulties in interpretation of results. There is a real need for an international consensus on standardization of PCR techniques.