Place de l'allogreffe de cellules souches hématopoïétiques dans le traitement des hémopathies malignes de l'adulte

Hematologic malignancies are the main indication for allogeneic stem cell transplantation. During the past decade many progress in immunosuppressive therapy and management of infectious complications led to a diminution of the toxicity of stem cell transplantation, but the mortafity and morbidity are still important. The development of reduced-intensity conditioning regimens, less toxic, and the emergence of new sources of hematopoietic stem cell (peripheral stem ceil and cord blood) have permit to enhance the indication of allograft, but the choice between the different procedures is more difficult. However late complications are similar for both standard and reduced regimens. Best analysis and treatment of GVH (Graft versus Host Disease) are necessary. The long term results for reduced-intensity conditioning regimens need to be evaluated by prospective study. Every allograft decision needs to be evaluated for the benefit and the risk for each patient.