After the conditioning regimen there is the “aplastic phase” (neutropenia) until neutrophils recover at approximately 14 days after peripheral blood stem cell transplantation, approximately 21 days after bone marrow transplantation, and approximately 30 days after umbilical cord blood transplantation (UCBT). The reconstitution of different immune cell subsets after an allogeneic HSCT occurs at different tempos. We provide an update on selected issues of development in this fast evolving field however, we do not claim completeness. The groundwork has been prepared for the creation of individualized therapy partially based on genetic features of the underlying disease. Although a slow T-cell reconstitution is regarded as primarily responsible for deleterious infections with viruses and fungi, graft-versus-host disease, and relapse, the importance of innate immune cells for disease and infection control is currently being reevaluated. New developments of allogeneic HSCT, for example, umbilical cord blood or haploidentical graft preparations leading to prolonged immunodeficiency, have further increased the need to improve immune reconstitution. An increasing variety of approaches has been explored preclinically and clinically: the application of cytokines, keratinocyte growth factor, growth hormone, cytotoxic lymphocytes, and mesenchymal stem cells or the blockade of sex hormones. Enhancing immune reconstitution is therefore an area of intensive research. Unfortunately, cure is often hampered by relapse of the underlying disease, graft-versus-host disease, or severe opportunistic infections, which account for the majority of deaths after HSCT. Allogeneic hematopoietic stem cell transplantation (HSCT) has advanced to a common procedure for treating also older patients with malignancies and immunodeficiency disorders by redirecting the immune system.
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