Bone marrow transplantation in children and cord blood transplantation

Abstract

Bone marrow transplantation has been used in children for treatment of an increasing number of malignant and benign hematological diseases and of solid tumors. The source of bone marrow for transplantation in most cases is an allogenic donor including related HLA-identical, related one HLA antigen mismatch, non-related HLA-identical or, in rare instances, related with 2 or 3 HLA mismatches. Cells from placenta and cord blood (PCB) have also been considered for related or unrelated allogenic transplantation with promising results. Factors like the relative feasibility of collection, flexibility in regards to HLA compatibility between patients and donors and the possibility of storage in cell banks contribute to the development of cord blood transplantation. Most patients treated for solid tumors receive autologous transplantation from bone marrow or peripheral blood. Complications of transplantation still include early or late toxicity from conditioning regimens, acute or chronic graft-versus-host disease, infections, prolonged immnunodeficiency and relapse of initial disease. Prolongation of survival of transplanted patients, specially in the pediatric population, raises concern about late complications that worsen the results, including poor quality of life, crippling organic and neuropsychosocial disabilities. Ongoing research conducted in this field will contribute continuosly to reduce post-transplant complications, increasing survival, both quantitatively and qualitatively.