Who is fit for allogeneic transplantation?

Area of Science:

• Hematology
• Oncology
• Transplantation Medicine

Background:

• Allogeneic hematopoietic cell transplantation (HCT) use has expanded due to donor availability and older patient inclusion.
• Increasingly, patients undergo HCT after failing other therapies, often presenting with refractory or advanced diseases.
• Novel non-transplantation treatments have emerged, influencing HCT indications and patient selection.

Purpose of the Study:

• To review the expanded indications and evolving landscape of allogeneic HCT.
• To highlight patient selection criteria, focusing on disease status and patient-specific factors.
• To discuss factors influencing HCT success, including pre-transplant response and post-transplant care.

Main Methods:

• Literature review of allogeneic HCT expansion and outcomes.
• Analysis of patient characteristics influencing transplant success and risk.
• Discussion of pre- and post-transplant management considerations.

Main Results:

• Patients with refractory/advanced disease often relapse post-HCT, especially with reduced-intensity conditioning.
• Older patients and those with comorbidities have higher risks of relapse and non-relapse mortality.
• Pre-HCT remission or response to therapy significantly improves transplantation success.

Conclusions:

• Careful patient selection is critical for allogeneic HCT, particularly for older patients or those with comorbidities.
• Achieving remission before HCT is associated with better outcomes.
• Robust social support, financial security, and comprehensive patient education are vital for managing HCT and its long-term effects.