Determining eligibility for allogeneic hematopoietic cell transplantation
- H Joachim Deeg, MD
H Joachim Deeg, MD
- Professor of Medicine, University of Washington
- Member, Fred Hutchinson Cancer Research Center
- Brenda M Sandmaier, MD
Brenda M Sandmaier, MD
- Professor of Medicine, University of Washington
- Member, Fred Hutchinson Cancer Research Center
Hematopoietic cell transplantation (HCT) is a general term that encompasses a series of procedures in which the patient is treated with chemotherapy, radiation therapy, or both (referred to as the "preparative/conditioning regimen") followed by the infusion of hematopoietic stem/progenitor cells. Various strategies for HCT have been developed and are applied, dependent upon the patient’s disease and disease stage, the hematopoietic cell donor, and the source of hematopoietic progenitor cells. The assessment of those parameters, in turn, will affect the selection of the preparative regimen. These factors influence the efficacy of HCT and the short and long-term toxicities associated with the procedure. (See "The approach to hematopoietic cell transplantation survivorship", section on 'Terminology'.)
Allogeneic HCT (allo-HCT) uses hematopoietic progenitor cells collected from a healthy person (not from the patients themselves). Allo-HCT is increasingly used to treat a variety of hematologic neoplasms and nonmalignant marrow disorders (acquired and inherited), including inborn errors of metabolism. Eligibility for allo-HCT varies across countries and institutions. Ultimately, decisions regarding transplant eligibility should be made on a case-by-case basis dependent upon a risk-benefit assessment, and the needs and wishes of the patient. Here we discuss eligibility for allo-HCT. Eligibility for autologous HCT, the use of HCT in specific disease settings, and the short- and long-term complications of HCT are discussed separately. (See "Determining eligibility for autologous hematopoietic cell transplantation" and "Hematopoietic support after hematopoietic cell transplantation" and "Quality of life following hematopoietic cell transplantation" and "Management of the hematopoietic cell transplant recipient in the immediate post-transplant period" and "The approach to hematopoietic cell transplantation survivorship".)
IMPACT OF UNDERLYING DISEASE
Disease-related indications — Historically, allo-HCT was offered to patients with hematologic malignancies who had exhausted other treatment modalities, and eligibility was largely based upon whether the patient was in adequate physical condition to tolerate the anticipated toxicity. Currently, a decision to perform allo-HCT must include an assessment of the underlying disease state and whether allo-HCT is likely to offer results superior to those achieved with nontransplant options. The risks of morbidity and mortality associated with allo-HCT must be compared with those of other treatment approaches.
The role of allo-HCT in specific diseases is discussed in more detail separately. In general, allo-HCT may be considered in the following settings:
●Acute myeloid leukemia – As post-remission therapy for patients in first or subsequent remission. (See "Post-remission therapy for acute myeloid leukemia in younger adults", section on 'Myeloablative allogeneic transplantation' and "Treatment of relapsed or refractory acute myeloid leukemia", section on 'Hematopoietic cell transplantation'.)
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- IMPACT OF UNDERLYING DISEASE
- Disease-related indications
- Disease type and status
- PRETRANSPLANT ASSESSMENT
- IMPACT OF INDIVIDUAL FACTORS
- Infectious disease status
- Weight and nutritional status
- RISK ASSESSMENT SCORING SYSTEMS
- EBMT score
- PAM score
- HCT-CI score
- HCT-CI/age composite score
- DONOR AVAILABILITY
- RACE, SOCIAL, AND ECONOMIC ISSUES
- DETERMINING ELIGIBILITY