TY - CHAP M1 - Book, Section TI - Basics of Bone Marrow Transplantation A1 - Rowe, Julie H. A1 - Gonzalez, Anneliese O. A1 - Jafri, Syed H. A1 - Cen, Putao A1 - Kanaan, Zeyad A1 - Amato, Robert J. A1 - Rios, Adan A1 - El-Osta, Hazem A1 - Mohlere, Virginia Y1 - 2019 N1 - T2 - Hematology-Oncology Clinical Questions AB - Table Graphic Jump Location|Download (.pdf)|PrintKey conceptThe most common indication for an SCT—specifically, autologous SCT—in the United States remains multiple myeloma. Acute myeloid leukemia (AML), by contrast, is the most common indication for allogeneic SCT.1 The indications for SCTs have continuously been refined by incorporating the cytogenetic composite and biology of tumors, and these are continuously compared against novel therapeutics to determine the safest and most effective approaches.Clinical scenarioA 47-year-old man is diagnosed with Philadelphia chromosome–negative acute lymphoblastic leukemia (ALL). Cytogenetic analysis reveals a mixed-lineage leukemia translocation. He is treated with modified hyper-CVAD chemotherapy, achieving a complete remission. He relapses 2 months later while on therapy. He receives re-induction therapy with blinatumomab, achieving a second complete remission followed by an allogeneic SCT from a sibling donor who is a 9/10 HLA match.Action itemsThe discussion of an SCT should be held with patients and transplant hematologists early during the course of treatment, as soon as it becomes a consideration. The pre-transplant evaluation, and, in allogeneic SCTs, the donor search, can be a lengthy process, and an early referral can prove valuable.DiscussionAllogeneic SCTAMLRelapsed/refractory diseasePoor-risk disease based on cytogeneticsAML with FLT3-ITD mutation2Treatment-related AML (t-AML) unless good risk cytogeneticsSecondary AML (eg, secondary to myelodysplastic syndrome or myeloproliferative disorders)ALLPoor-risk ALL based on cytogeneticsMinimal residual disease positivity by flow cytometry at the end of induction3Consider if presenting with white blood cell counts >30,000/µL in B-ALL, >100,000/µL in T-ALL, age >30–35, or failure to achieve a complete remission in 4 weeksMyeloproliferative disordersBlast-phase chronic myeloid leukemiaMyelofibrosis: Dynamic international prognostic scoring system-plus intermediate-2 score or high risk, and in high-risk molecular features4Myelodysplastic syndromeInternational Prognostic Scoring System intermediate-2 score or high risk5Bone marrow failure syndromesAplastic anemiaCongenital marrow failure syndromesAutologous SCTMultiple myelomaRelapsed/refractory diffuse large B cell lymphomaMantle cell lymphoma in first complete remission6Peripheral T cell lymphoma in first complete remission7Relapsed/refractory Hodgkin lymphomaRelapsed follicular lymphomaRelapsed acute promyelocytic leukemia (APL) if molecular remission is achievedPearlsWith the exception of APL, acute leukemias require the graft-versus-tumor effect of an allogeneic SCT in cases when an allogeneic SCT is indicatedWith the exception of ALL, autologous transplantation is used in lymphoid malignanciesOwing to the defective stem cells in patients with bone marrow failure syndromes, treatment is with an allogeneic SCT when indicatedAutologous SCT can be a non-curative modality to achieve a prolonged progression-free and treatment-free survivalThe role and sequencing of autologous SCT for multiple myeloma had been and remains a constant topic of discussion among experts, more recently owing to the approval of several anti-myeloma therapeuticsAllogeneic SCT can be curative in conditions traditionally treated with autologous SCTs or non-transplant approaches; however, its risks outweigh its benefitsInstitutions vary in their morbidity and mortality outcomes of SCTs, and the decision to transplant or not requires a continuous evaluation of patients’ comorbidities and social support and should be weighed against the institution’s outcomesReferencesData from the Center for International Blood and Marrow Transplant Research (CIBMTR). 2014. Available at: https://www.cibmtr.org.DeZern A, Sung A, Kim S, et al. Role of allogeneic transplantation for FLT3/ITD acute myeloid leukemia: outcomes from 133 consecutive newly diagnosed patients from a ... SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - hemonc.mhmedical.com/content.aspx?aid=1162981397 ER -