A history of haemopoietic cell transplantation

Fifty years have gone by since the first experiments that were to lead to the wide application of haemopoietic cell transplantation. Many disciplines have been involved including radiation biology, immunology, molecular biology, drug development, blood component transfusion technology and numerous adult and paediatric clinical disciplines. At every turn, the solution of problems depended heavily on animal research ranging from mice to dogs to non-human primates. At present more than 20000 human transplantations of haemopoietic cells from marrow, peripheral blood or cord blood are being performed annually. Initially these cellular transplantations were carried out only in terminally ill patients, but now in many instances transplantation is the preferred treatment and is carried out early in the course of the disease. Exciting research designed to continue improvement of the application to human patients includes the achievement of engraftment without lethal marrow ablative regimens, the use in autoimmune diseases, and the development of techniques for inducing tolerance for solid organ grafting. The development of effective anti-viral and anti-fungal drugs and the shift to out-patient care has resulted in dramatic reduction of the cost of transplantation as well as improved long-term survival. Pending the development of highly specific curative agents, it is likely that the use of haemopoietic cell transplantation will continue to increase during the early years of the third millenium.