Table Of ContentA Guide to Blood and Marrow Transplantation
Springer-Verlag Berlin Heidelberg GmbH
H.J. DEEG H.-G. KLINGEMANN
G.L. PHILLIPS G. VAN ZANT
AG uide to
Blood and Marrow
Transplantation
Third Completely Revised Edition
With 12 Figures and 32 Tables
t
Springer
H. JOACHIM DEEG, M.D. GORDON 1. PHILLIPS, M.D.
Fred Hutchinson Cancer Research Center Director, BMT Program
1100 Fairview Ave. North Markey Cancer Center
P.O. Box 19024 University of Kentucky
Seattle, WA 98109-1024 800 Rose St.
U.S.A. Lexington, KY 40536-0093
U.S.A.
HANS-GEORG KLINGEMANN, M.D., PH.D.
Coleman Foundation Professor of Medicine GARY VAN ZANT, PH.D.
Director, Section of Bone Marrow Director, Stem Cell Laboratories
Transplantation Blood and Marrow Transplant Program
Rush-Presbyterian-St. Luke's Medical Center University of Kentucky Medical Center
1653 West Congress Parkway 800 Rose St.
Chicago, IL 60612 Lexington, KY 40536-0093
U.S.A. U.S.A.
ISBN 978-3-642-62122-2
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A Guide to blood and marrow transplantation / H.J. Deeg ... (ed.). -3., completely rev. and en!. ed.
Berlin; Heidelberg; New York; Barcelona; Budapest; Hong Kong; London; Milan; Paris; Singapore;
Tokyo: Springer, 1998.
2. Aufl. u.d. T.: A Guide to bone marrow transplantation
ISBN 978-3-642-62122-2 ISBN 978-3-642-18248-8 (eBook)
DOI 10.1007/978-3-642-18248-8
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Preface to the Third Edition
The first edition to A Guide to Bone Marrow Transplantation was published 10
years ago. At that time we perceived a need for an introductory text to the area of
marrow transplantation, a rapidly developing field with few general texts avail
able. Since then the situation has changed dramatically. Several introductory
texts, therapeutic manuals and comprehensive volumes have been published.
There is a heightened awareness of the availability, utility and potential of bone
marrow transplantation, and of peripheral blood stem cell transplantation in
particular. In many cases stem cell transplantation is being practiced by physi
cians as a standard therapy.
For those reasons we weighed carefully the question whether the Guide was still
useful or even had a place. The feedback we received from physicians in practice
or in training (including both hematologists and other physicians), as well as
from nurses, physician's assistants, nurse practitioners, and other personnel in
volved in one way or another in hematopoietic stem cell transplantation indicat
ed that such a text was still desirable as an introduction that focused on princi
ples rather than the latest up-to-date results.
As before, we have aimed at maintaining a concise text. We decided to change the
title to cover more broadly the field of hematopoietic cell (rather than only mar
row) transplantation and, because of numerous new developments, a fourth au
thor (GVZ), who comes with considerable expertise in stem cell biology, was add
ed. We have restructured the contents to emphasize various sources of stem cells
as well as their collection, processing and potential expansion. We also have ex
panded our discussion on the prevention and treatment of disease recurrence af
ter transplantation in view of the progress that has been made with immunother
apy, in particular, and with attempts that are currently being made with gene
manipulation. Furthermore, longer observation in larger cohorts of patients now
allows for more comprehensive studies on long-term results as well as delayed ef
fects, and this has been emphasized. Finally, we have added a more detailed index
to allow readers to orient themselves more quickly and easily.
As in previous editions, the Guide was not written as a manual on how to carry
out stem cell transplants. The focus has remained on principles guiding our ap
proach to the management of patients who undergo transplantation.
We thank all those who have given generously of their time and expertise to make
this book possible, Drs. J. Wingard and C. Pomeroy in particular. We give special
thanks to Ms. Monika Schrimpf from Springer-Verlag for her understanding and
for accommodating many last-minute changes, as well as to other staff members
VI Preface to the Third Edition
of Springer-Verlag for their support. We would like to thank B. Larson and H.
Childs for their help with manuscript preparation and editing.
Seattle, Chicago, Lexington H. JOACHIM DEEG
HANS-GEORG KLINGEMANN
GORDON L. PHILLIPS
GARY VAN ZANT
Preface to the Second Edition
In 1988 we presented out Guide to Bone Marrow Transplantation. The reception
has been enthusiastic and we have received a flood of critical comments, sugges
tions and requests to provide an update in due time. Although several books on
marrow transplantation have recently been published, their scope and goal have
generally been different. Hence, we have decided to prepare a second edition of
the Guide.
Our aim was to maintain a short, concise text which nevertheless would incorpo
rate changes that have occurred over the past four or five years. We have stream
lined the description of pretransplant considerations, by condensing two sections
into one (Treatment Planning and Timing of Transplantation). This also facilitat
ed the review of controversial indications for marrow transplantation, for exam
ple in patients with acute myelogenous leukemia in forst chemotherapy-induced
remission. We have updated the chapter dealing with conditioning regimens and
have expanded the section on domor selection, in particular in regard to the cur
rent level of tissue typing and the identification of unrelated volunteer donors. In
the chapter on collection, processing, and infusion of marrow, we have incorpo
rated recent developments, for example, the use of closed systems for marrow
harvesting and processind and the use of solid phase separation of stem cells.
In the section dealing with acute transplant-related complications, we have added
recent results on graft-versus-host disease prevention, and we have included up
to-date information on the prevention of cytomegalovirus (-related disease by
the use of CMV-negative blood products and treatment with ganciclovir.
We have reworked thoroughly the section on delayed transplant-related compli
cations since a considerable amount of data has accumulated. We have added a
section on complications not previously addressed (for example, dental abnor
malities) and added a chapter on rehabilitation. Finally, to facilitate retrieval of
information, we have generated a small index.
Despite all efforts it is likely that already at the time of publication of this book
new results and insights not available at the time of this writing will have
changed our approach to certain problems in the field.
We emphasize again that the book was not conceived as a manual on how to do
marrow transplants nor as a textbook giving countless statistics. The goal
remains that of an overview of principles and concepts of marrow transplanta
tion for those who are not necessarily confronting these issues on a daily basis.
We thank all those who have given generously of their time and effort to make
this book possible. We thank expecially Dr. V. Gebhardt and the staff of Springer-
VIII Preface to the Second Edition
Verlag for their responsiveness and support, Drs. T. Nevill and J. Wingard for
reading the manuscript and for their suggestions, and Ms. 1. Williams, B. Larson,
and D. Gayle for their help with manuscript preparation and editing. We also
wish to acknowledge the continued support of our teachers, especially Rainer
Storb and E. Donnall Thomas.
Seattle and Vancouver H. JOACHIM DEEG
HANS-GEORG KLINGEMANN
GORDON 1. PHILLIPS
Preface to the First Edition
In the late 1940s investigators observed that mice given supralethal doses of total
body irradiation were protected by infusion of viable spleen or marrow cells fol
lowing irradiation, and that this was accomplished by hemopoietic reconstitution
with donor cells as proven using genetic markers. If a similar approach could be
applied to humans, it should be possible to treat leukemia patients with any dose
of chemoradiotherapy as far as nonmarrow toxicity permitted, and then rescue
them by marrow transplantation. Early clinical attempts were generally unsuc
cessful, mostly due to a lack of knowledge of histocompatibility antigens and
appropriate supportive care. These areas developed rather quickly during the
1960s, and for almost two decades now clinical marrow transplantation has been
carried out with increasing success. After initially using only bone marrow from
HLA indentical siblings, the field has expanded rapidly to incorporate HLA non
identical related donors, and recently even marrow from unrelated volunteer
donors. Furthermore, since for numerous patients who otherwise could benefit
from transplantation a donor cannot be identified, there has been a growing
interest in using the patient's own (autologous) bone marrow.
Our understanding of the principles of transplantation and our knowledge of the
potential risks and benefits have quickly grown. At times it is difficult, however, to
decide what is the best option for a given patient. This problem is further accen
tuated by the fact that the nontransplant management of the patients under con
sideration (e.g., patients with severe aplastic anemia, acute or chronic leukemia,
lymphomas) has improved concurrently. Rather than being used in a comple
mentary fashion, they have often been presented as competing options.
Therefore, we felt that there was a need for a text that would address these issues.
Conceivably, if all treatment options including bone marrow transplantation are
included in treatment planning early after a patient's diagnosis is established,
they can be applied more intelligently, hopefully with reducted toxicity, and
hence at less risk for the patient. Consequently long-term results should improve.
From a psychological point of view this may also allow a patient more time to
weigh the various options and adjust to potential problems.
Although this book is directed primarily at internists and pediatricians, in par
ticular hematologists and oncologists treating patients who might benefit bone
marrow transplantation, we believe that it will also be of interest to other physi
cians, students and physicians in training, nurses, technologists involved in mar
row transplantations, patients, and possibly those involved in insurance ques
tions and other administrative aspects.
x
Preface to the First Edition
Our aim was to present each achapter and section in this book as a closed entity.
Of necessity this has led to some overlap and duplication of sections of the dis
cussion which appear to be pertinent in more than one place. We believe this may
actually be an advantage since the readers will find any topic of interest under
one heading rather than having to go through the entire book.
We are indebted to our teachers who introduced us to the exciting field of bone
marrow transplantation, to our patients who gave us the gratifying experience of
success, and to our colleagues and students who continue to challenge our views.
We would like to thank our secretaries for their never-fatiguing support during
the preparation of the manuscript, and the staff of Springer-Verlag, especially Dr.
J. Wieczorek, for their responsiveness to our requests and the ability to accommo
date last-minute modifications. We hope that we have not neglected any of our
other duties during the preparation of the manuscript, but if we have done so we
hope that the benefits of this book will allow us to make good for it.
H. JOACHIM DEEG
HANS-GEORG KLINGEMANN
GORDON L. PHILLIPS
