Nejm 1994;330:827

HLA-matched (Nejm 1990;322:485; Ann IM 1989;110:51). Useful for various conditions: Wiskott-Aldrich syndrome, aplastic anemia, combined immunodeficiency (even non-HLA matched works—Nejm 1999;340:528), Fanconi's anemia, Hurler's disease, possibly thalassemia major (40-50% survival), possibly sickle cell disease, hematologic cancers, some solid tumors like breast, ovarian, melanoma, and glioma. Costs $150000-500000 and for some diseases may be no better than standard rx

Placental/cordblood source more available and often better w less GVH disease (Nejm 2001;344:1818; 2000;342:1846), 75% success (Nejm 1998;339:1565; Med Let 1996;38:71), esp if can't match (Nejm 2004;351:2265, 2276, 2328)

Peripheral blood stem cells from a donor after filgrastim (granulocyte colony-stimulating factor) are better source for transplant (Nejm 2001;344:175; Ann IM 1997;126:600)

• Rejection: use methotrexate + prednisone + antithymocyte globulin (Nejm 1982;306:392); avoid transfusion of blood or platelets beforehand, which diminishes success from 75% to 25% (Ann IM 1986;104:461)
• Graft-vs-host disease (rv—Nejm 1991;324:667) including bronchitis (Nejm 1978;299:1030), skin, gi tract, and liver (venoocclusive disease—Ann IM 1979;90:158), latter prevented w ursodiol prophylaxis (Ann IM 1998;128:975)
• B-cell lymphoproliferative syndromes from "mono" to lymphoma (Nejm 1991;324:1451)
• Solid tumors (melanoma, squamous cell, thyroid, bony, CNS) all increased × 2.5-4, 5-10 yr out (Ann IM 1999;131:738; Nejm 1997;336:897)

Rx:Prophylactic pneumovax against increased pneumococcal disease (Ann IM 1979;91:835); acyclovir against herpes simplex (Nejm 1981;305:63); CMV immune plasma against CMV (Ann IM 1982;97:11)

Filgrastim, a granulocyte-stimulating factor, can reinduce transplanted marrow growth (Nejm 1993;329:757)