History of hematopoietic cell transplantation: challenges and progress

Abstract

After more than 60 years of research in allogeneic hematopoietic cell transplantation (HCT), this therapy has advanced from one that was declared dead in the 1960s to a standard treatment of otherwise fatal malignant and non-malignant blood diseases. To date, close to 1.5 million hematopoietic cell transplants have been performed in more than 1,500 transplantation centers worldwide. This review will highlight the enormous efforts by numerous investigators throughout the world who have brought the experimental field of HCT to clinical reality, examine ongoing challenges, and provide insights for the future.

Figure 1.

Improved outcomes of allogeneic hematopoietic cell transplantation with non-myeloablative conditioning for older and medically infirm patients with hematologic malignancies over two decades at Fred Hutchinson Cancer Research Center (WA, USA). Overall survival (A), progression-free survival (PFS) (B), nonrelapse mortality (NRM) (C), and incidence of relapse (D) by time period of transplant: 1997-2003 (black line), 2004-2009 (blue line), and 2010-2017 (red line) (from Cooper et al.; with permission).

Figure 2.

Trends in allogeneic hematopoietic cell transplantation (HCT) over two decades in North America. Donor source (A), transplant indications (B). 2019 data from the Center for International Blood and Marrow Transplant Research (CIBMTR).106 ALL: acute lymphoblastic leukemia; AML: acute myeloid leukemia; CLL: chronic lymphocytic leukemia; CML: chronic myelogenous leukemia; MDS: myelodysplastic syndrome; MM: multiple myeloma; NHL/HL: non-Hodgkin lymphoma/ Hodgkin disease; URDCB: unrelated donor cord blood; URD-PB: unrelated donor peripheral blood; URD-BM: unrelated donor bone marrow.