Bone Marrow Transplantation in Thalassemia (Part 1)

• Main Author: Maryam Zakerinia
• Format: Article
• Language: English
• Published: Shiraz University of Medical Sciences 2009-03-01
• Series: Iranian Journal of Medical Sciences
• Subjects: Bone marrow transplantation; thalassemia; graft-versus-host-disease
• Online Access: http://ijms.sums.ac.ir/files/PDFfiles/34_1_01-Dr_%20Zakerinia.pdf819498281.pdf

During the last two decades conventional therapy has improvedthe prognosis of thalassemia. However, despite such improvementit still remains a progressive disease with treatment-related complicationssuch as hepatitis, liver fibrosis, and cardiac disease.Bone marrow transplantation (BMT) can prevent or delay progressionof the aforementioned complications. The importance ofclinical research in the field of BMT was recognized with theaward of the 1990 Nobel Prize in Physiology and Medicine to E.Donnall Thomas, one of the pioneers of BMT in humans. GeorgeMathe' was a pioneer in the early development of clinical BMT.Mathe' et al. were the first to describe graft-versus-host-disease(GVHD) and its treatment, and the graft-versus- leukemia (GVL)effect in human. The first BMT for β-thalassemia major was performedsuccessfully by Thomas et al. in Seattle, in 1981. In thesame year another patient with β-thalassemia major underwentBMT in Pesaro, Italy, by Lucarelli et al. Since then, several hundredtransplantations have been performed worldwide, the majorityof these in Italy. From 1991 through 2007 BMT have beenperformed on 497 (Tehran=342, Shiraz=155) blood transfusiondependent patients with thalassemia major in Iran, with diseasefreesurvival of 71-77% respectively. Due to high graft failureand GVHD rates, BMT from alternative donors should be restrictedto patients who have poor life expectancies because theycannot receive adequate conventional treatment or because of alloimmunizationto minor blood antigens. Beginning in the early1980s, it was shown that umbilical cord blood contained high levelsof hematopoietic progenitor cells.