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Abstract
The rapidly expanding field of stem cell biology has resulted in a dramatic improvement in our understanding of the biologic basis of transplantation. With the emergence of PBPCs and umbilical cord blood, alternative sources of stem cells are available. The optimal source and composition of the stem cell product continues to be an area of active clinical investigation.
Progress in the supportive care of patients who are immunocompromised, due either to their underlying disease or as a consequence of therapy, has been critically important in improving overall treatment results. Among patients undergoing hematopoietic cell transplantation, advances in hematopoietic support, improvements in antibiotics, antifungal agents, and antiviral drugs, and better medications to control side effects of treatment such as nausea, vomiting, diarrhea and pain have all had a major impact on the clinical course.
In terms of decreased morbidity and mortality after autologous transplantation, probably the single most important advance has been the introduction of mobilized peripheral blood progenitor cells (PBPCs) as the source of stem cells. This approach results in more rapid recovery, which has significantly reduced the duration of antibiotic therapy, the degree of mucositis, the length of hospitalization, and the risk of the transplant procedure itself. These positive developments have resulted in a marked decline in the discomfort that patients experience in the transplant setting.