A Historical Review of Hematopoietic Stem Cell Transplantation: Developmental Advancements Then and Now

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2023-04-23

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Abstract

A review of the history of regenerative medicine focusing on the use of hematopoietic stem cells (HSCs) from their initial inception in bone marrow transplantation for blood disorders and diseases to their expanded uses today through advancements in technology. Commonly treated malignant and non-malignant bone marrow transplant conditions include but are not limited to leukemia, non-Hodgkin lymphoma, and aplastic anemia. Bone marrow transplants are performed by autologous or allogeneic transplantation with multipotent HSCs. The first unrelated allogeneic transplant was performed by Dr. Edward Donnall Thomas in 1957. The initial approaches using stem cells as a form of treatment resulted in great difficulty and failure with few exceptions. However, discoveries such as the major histocompatibility complex within humans known as the human leukocyte antigen (HLA), allowed researchers to identify genetic matches between donors and recipients resulting in an increased rate of successful procedures. Since then, advancements in the field have introduced new techniques that improve the efficacy of hematopoietic stem cell transplantation and expanded use to more populations. Such advancements include improved conditioning regimens, matched unrelated donors, umbilical cord HSCs, and more potent immunosuppressants and antimicrobial drugs. For patients that experience tissue damage due to conditioning regimens or cancer malignancy, HSCs use a “homing” mechanism to mobilize to the affected area and release chemical factors that promote tissue recovery. Patients that undergo transplantation are put at risk of several conditions including graft-versus-host disease and opportunistic infections, however, complication-prevention regimens have been put in place to decrease the mortality rate. This literature review serves to roughly gauge how this field of medicine has developed since the 1950s and where future implications lie. Said implications include emerging ways to treat graft-versus-host disease, improved HLA typing matches, and HSC uses in transplantable organs like the liver.

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Keywords

Stem cells, Hematopoietic stem cells, Transplant, Regenerative medicine, Regeneration, Biology

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