Selection of Candidates for Marrow Transplantation

How to chose the best patient for Marrow Transplantation?

Patient-related factors that affect Marrow Transplantation

Most marrow transplantation candidates are referred by hematologists or oncologists to the tertiary center where the marrow transplantation procedure will be performed. Patients considered for Marrow Transplantation require in-depth counseling by experienced transplantation physicians, nurses, and social workers who are knowledgeable in the field. Information regarding the prior course, including initial diagnostic studies, previous drug and radiation treatments, and responses to these interventions, as well as a psychosocial assessment of the patient and their caregivers, are of the utmost importance.

Important factors have been identified that consistently impact results following stem cell transplantation and include, but are not limited to, disease status at transplantation, type and compatibility of donor, recipient’s age, and comorbid medical conditions.

Disease status at the time of Marrow Transplantation 

Disease status at the time of marrow transplantation is perhaps the most powerful predictor of long-term disease-free survival following allogeneic and autologous stem cell transplantation. Early transplantation studies of allogeneic stem cell transplantation were performed using predominantly patients whose disease failed to respond to a variety of other treatment strategies. Although a small percentage of these patients were salvaged, transplantation was unsuccessful in the majority of patients. Results following treatment of patients earlier in the course of disease are superior.

Disease status, as determined by positron emission tomography (PET), was an important predictor of progression-free survival for patients with diffuse large B-cell lymphoma and HL undergoing autologous cell transplantation . Evidence of residual disease by PET prior to transplantation was associated with a significantly increased risk for relapse after autologous cell transplantation. These two scenarios highlight a general truism: that patients who have advanced stages or poorly controlled disease at the start of transplant conditioning have significantly inferior outcomes compared to patients transplanted earlier in the course of their disease and to those who have achieved good, albeit temporary, control of their disease.