Hematopoietic stem cell research and transplantation: Genesis, development and prospects for the 21st century.

摘要

Hematopoietic Stem Cell Transplantation (HSCT) is one of the great therapeutics advances that medicine achieved in the twentieth century. It started in the 1950s as treatment for acute leukemia in patients who had an identical sibling.;At the beginning the whole suspension of bone marrow cells was used. The definition of the Human Histocompatibility System (HLA) helped to improve the therapy and its application widened as HLA compatible unrelated individuals became eligible for bone marrow donation. The discovery that T cells were the cause of rejection made possible their elimination from the suspension before it was infused into the patient; this facilitated engraftment and brought great benefit to recipients.;Hematopoietic stem cells were described in 1961 by McCulloch and Till. The study, and characterization of these wonder-working cells for application in stem cell transplantation to treat hematological and immune diseases continues today. Currently, the therapy is also applied to treat an increasing and varied list of cancer that originate in different sites of the body.;Medical Humanities plays an important role in guarding the patients' autonomy as well as in the development of a person-oriented medicine. The discipline has helped to turn the art of medicine into a more human and benevolent science. For physicians are becoming more aware of the need to treat not only the disease, the patient who suffers physiological and biochemical alterations of the organism, but also the human being with a mind full of trepidation, intense apprehension, and even fear.;This dissertation deals with scientific historic facts that brought hematopoietic stem cell transplantation to the place it holds today in the field of therapeutics as it is applied in the treatment of very dreaded diseases. It also exposes the role that the discipline of Medical Humanities has played, and still plays, in the linkage of ethical norms of society with the scientific advances that medicine has achieved, particularly, those that refer to the application of hematopoietic stem cell transplantation.