Hematopoietik kök hücre transplantasyonu (HKHT), malign ve malign olmayan hastaliklarda 3 dekattan daha fazla süredir tedavi yaklasimi olarak basari ile kullanilmaktadir. HKHT, kök hücre kaynagi olarak kemik iligi, periferik kan ya da kordon kani kullanilarak elde edilen kök hücrelerin, çogu zaman hazirlayici bir rejim uygulamasi sonrasinda bazen de direkt olarak, hastaya intravenöz olarak verilmesiyle gerçeklestirilmektedir. Son zamanlarda otoimmün hastaliklar, AL amiloidoz gibi durumlarda otolog, solid tümörlerde allojeneik transplantlar gibi yeni endikasyonlar ortaya çikmistir. Ayrica imatinib gibi alternatif tedavilerin kullanima girmesi de, çok iyi bir allojeneik transplant endikasyonu olan kronik myeloid lösemilerde HKHT’nu ikinci plana atmistir. Bazi moleküler genetik bulgulara ait veri birikimleri de yeni endikasyonlar yaratmistir.

ALL tedavisinde, hem Avrupa ülkelerindeki (ALLIC-BFM ile birçok kitadaki çesitli ülkelerde), hem de ülkemizdeki birçok merkezin kullandigi BFM protokollerinde, HKHT endikasyonlarinda rol oynayan en önemli faktörlerden birisi minimal kalintili hastalik (minimal residual disease) takibidir. Minimal kalintili hastalik izlemi yapamayanlar (ALLIC-BFM protokolünde oldugu gibi) diger parametreleri kullanarak, transplant endikasyonlarini koymaktadirlar. Tablo 6’da CR1’deki, Tablo 7’de ≥CR2’deki transplant endikasyonlari verilmistir. Tablo 8’de S2 kolu alt gruplari, Tablo 9’da izole merkezi sinir sistemi (MSS) relapsi risk gruplari belirtilmistir. Izole MSS relapsinda yüksek risk grubunda otolog HKHT önerilmektedir.Türk Pediatrik KIT alt komitesi transplantasyon endikasyonlariIlk kez 2001 yilinda, pediatrik HKHT yapan 8 merkezin (Istanbul Üniversitesi Çapa Tip Fakültesi, Hacettepe Üniversitesi Tip Fakültesi, Ege Üniversitesi Tip Fakültesi, Akdeniz Üniversitesi Tip Fakültesi, Ankara Üniversitesi Tip Fakültesi, GATA Tip Fakültesi, Çukurova Üniversitesi Tip Fakültesi ve SSK Tepecik Hastanesi) katilimi ile ülkemizde yapilacak pediatrik HKHT endikasyonlari belirlenmistir. Ayni alt komite, aralarina Gazi Üniversitesi Tip Fakültesi’nin de katilimiyla 2007’de tekrar toplanmis ve endikasyonlar yeniden gözden geçirilmistir. Tablo 10 - 11 -12’de bu endikasyonlar gösterilmistir. Kaynaklar

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