Indications for hematopoietic stem cell transplantation

Abstract

Transplantation of hematopoietic stem cells derived from bone marrow or peripheral blood has been used as a therapeutic procedure since the mid-seventies. In recent years, the number of transplants reported annually to the European Group for Blood and Marrow Transplantation (EBMT) Registry is approximately 23,500 including 38% of allogeneic and 62% of autologous procedures. In most developed countries, the incidence of hematopoietic cell transplantations reaches 400/10 million inhabitants per year and 220/10 million per year in Poland. Further advances require both increased funding and improved public health system as a whole. To recommend transplantation, it is necessary to compare the risk associated with the disease itself versus that of the transplantation procedure which depends on the stage of the disease, patient's age, time interval from diagnosis to transplantation, donor type (siblings or unrelated subjects), sex of the donor and individual features. According to the EBMT recommendations, the following categories of indications have been used: "standard procedure" category--S, "clinical option"--CO, indication of "developmental" character--D and "generally not recommended"--NR. The tabular presentation of indications is an approximation since approach to each patient should be individualized. Generally, the most-common indications for auto-transplant treatment are myeloma, malignant lymphoma and acute myeloblastic leukemia while the main indication for bone marrow allotransplantation is acute myeloblastic leukemia (33% of all allotransplantations), lymphoblastic leukemia, dysmyelopoietic syndrome, chronic myeloblastic leukemia refractory to tyrosine kinase inhibitors, then lymphoid malignancies and non-malignant disorders (bone marrow aplasia, severe immunodeficiencies, paroxysmal nocturnal hemoglobinuria, etc.).