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Authors
Sigrún E.Þ. ReykdalIssue Date
2000-09-01
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Bone marrow transplantationCitation
Læknablaðið 2000, 86(9):593-9Abstract
For the last few decades there has been a major increase in the number of allogeneic bone marrow transplantations and every year several thousand transplants are performed. In the early days of transplantation the treatment was performed only in terminally ill patients but now transplantation is carried out early in the course of the disease with greatly improved results. The most common indications for treatment today include acute and chronic leukemia, Non-Hodgkin s lymphoma, Hodgkin s disease, multiple myeloma and congenital immune deficiencies. Sibling donors are the most common source of stem cells for transplantation but in recent years international donor registries have played an increasing role. Degree of HLA disparity between donor and recipient is the main risk factor for Graft versus Host disease which is still the major cause of morbidity and mortality after transplantation. Graft rejection is very rare when there is complete HLA match between the donor and recipient. Overall survival is also dependent on several other factors including disease stage at time of transplantation, age and disease categories. For the last few years an average of four Icelandic patients have received bone marrow transplantation each year and indicatioons are similar to other European countries.Allra síðustu áratugi hefur orðið mikil aukning á fjölda mergskipta en árlega fara mörg þúsund sjúklingar í slíka meðferð. Í dag eru mergskipti framkvæmd fyrr í sjúkdómsferlinu heldur en tíðkaðist í byrjun og hefur það leitt til bætts árangurs meðferðar. Illkynja blóð- og eitilfrumusjúkdómar eru algengustu ábendingar í dag. Helstu sjúkdómaflokkarnir eru hvítblæði, bæði brátt og langvinnt, eitilfrumukrabbamein (Non-Hodgkin´s lymphoma og Hodgkin´s disease), mergfrumuæxli (multiple myeloma) og meðfæddar ónæmistruflanir. Oftast er merggjafinn systkini sjúklings en á síðustu árum hafa alþjóðlegar gjafaskrár gegnt vaxandi hlutverki í leit að gjafa. Tegund vefjaflokkasamræmis milli þega og gjafa er helsti áhættuþáttur fyrir ónæmisröskun sem enn í dag er meginorsök alvarlegra veikinda og dauðsfalla við ígræðslumeðferðina. Höfnun græðlings er mjög sjaldgæf þegar um fullkomið vefjaflokkasamræmi er að ræða. Heildarlifun er einnig háð fjölmörgum öðrum þáttum, svo sem sjúkdómsgreiningu, aldri og framgangi sjúkdómsins. Síðustu ár hafa að meðaltali fjórir Íslendingar farið í mergskipti árlega en öll mergskipti hafa farið fram erlendis. Ábendingar eru svipaðar og í öðrum Evrópulöndum
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