![]() This shift in practice was based on studies that revealed that transplant outcomes are highly dependent upon timing. In addition to the constantly expanding list of indications, there has been a trend towards performing allogeneic HCT earlier in the course of the disease rather than employing this approach as a rescue attempt in the late or end stages of disease progression. Reprinted with permission from CIBMTR (2009). Indications for allogeneic hematopoietic cell transplantation in North America 2005ĭata from the Center for International Blood and Marrow Transplant Research (CIBMTR).ĪML: Acute myeloid leukemia ALL: Acute lymphoblastic leukemia CML: Chronic myelogenous leukemia MDS: Myelodysplastic syndrome MPD: Myeloproliferative disorders NHL: Non-Hodgkin lymphoma. In this article, we provide an overview of the most salient aspects of HCT, with a special focus on areas of active research and novel therapies. The field of HCT is extremely broad and incorporates elements of immunology, radiobiology, infectious disease and oncology. With this recognition, the use of allogeneic HCT has expanded rapidly over the past decades and its role will continue to evolve as advances in conditioning, supportive care, management of complications and expanding stem cell sources further widen its applicability. However, it soon became evident that much of the effectiveness of HCT in malignant diseases stemmed from the immunologic reactions of donor cells against malignant host cells. When developed initially, allogeneic HCT was considered an approach to rescue patients from the toxic side effects of supralethal doses of radiation and chemotherapy used to treat various underlying diseases by transplanting hematopoietic stem cells, which had the ability to reconstitute hematopoiesis. ![]() We conclude with a speculative outline of the next 5 years of research in the field of HCT.Īllogeneic hematopoietic cell transplantation (HCT) is a potentially curative procedure for a variety of malignant and non-malignant conditions. We review recent advances in the understanding of this phenomenon, and novel prophylactic and therapeutic approaches that hold the promise of further improving the safety of the procedure. Graft-versus-host disease remains a major cause of morbidity and mortality after HCT. We review three major approaches to broadening the donor pool: the use of HLA-mismatched unrelated donors, umbilical cord blood and HLA-haploidentical family donors. The availability of suitable donors may be an obstacle to wider application of HCT. Specifically, we will discuss approaches to reduce the toxicity of the preparative regimen, with the goal of increasing the safety and applicability of HCT. In this article, we provide an overview of the major aspects of allogeneic HCT, and focus specifically on areas of active research and on novel approaches to challenges in the field. As a result, the indications for HCT and the pool of eligible patients have expanded significantly. The field has evolved substantially over the past decade, with advances in patient and donor selection, stem cell sources, supportive care, prevention of complications and reduced-toxicity preparative regimens. Let me know if you are still having any issues.Allogeneic hematopoietic cell transplantation (HCT) is a potentially curative procedure for a variety of hematologic malignancies. New version, I have tightened up some of the PCB cases to make things a bit safer. I hope it helps version, just added a safety lockout condition on level up just to be safe in response to your comment. Also consider looking into some of the other stability comments in the mod description. I just put out a new version, the fixes in it might solve those issues for appear to be describing several of the scenarios that ZAPCB can help with. Since you are running in an emulator, you might have been getting hit by a during load PCB that was making things weird where the timing on a normal install would preclude that usually. ![]() I have some more low to high res texture popping in the distance with ZAPCB that I did not before, which is to be expected. * Multiple minor stability and performance strange. * Tightened up logic around cases that people reported problems with. * Preferentially calls PCB while motionless and not in combat now.
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