Indications and Outcome of Allogeneic Hematopoietic Cell Transplantation for Hematologic Malignancies in Adults

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Chapter 46 Indications and Outcome of Allogeneic Hematopoietic Cell Transplantation for Hematologic Malignancies in Adults

Parameswaran Hari, Mary Horowitz

Figure 46-1 INDICATIONS FOR ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION IN ADULTS (U.S. DATA), 2009.

AA, Aplastic anemia; ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; CLL, chronic lymphocytic leukemia; CML, chronic myeloid leukemia; HD, Hodgkin lymphoma; MDS, myelodysplastic syndrome; MPS, myeloproliferative disorders; NHL, non-Hodgkin lymphoma.

Figure 46-2 CONDITIONING REGIMEN INTENSITY AND PATIENT AGE—CHANGING TREND OVER TIME.

Table 46-1 Consensus Definition of Conditioning Regimen Intensity

Myeloablative Conditioning (MAC)
PROFOUND CYTOPENIA; NOT LIKELY TO RECOVER WITHOUT HEMATOPOIETIC CELL RESCUE
Total-body irradiation ≥5 Gy single dose or ≥8 Gy fractionated Busulfan >8 mg/kg orally or intravenous equivalent
Nonmyeloablative
MINIMAL CYTOPENIA; AUTOLOGOUS RECOVERY OF HEMATOPOIESIS LIKELY EVEN WITHOUT TRANSPLANT
Total-body irradiation ≤2 Gy ± purine analogue Fludarabine + cyclophosphamide ± antithymocyte Globulin Fludarabine + cytarabine ± idarubicin Cladribine + cytarabine Total lymphoid irradiation + antithymocyte globulin
REDUCED-INTENSITY CONDITIONING
Regimens that are intermediate between the above categories

Adapted from Bacigalupo A, Ballen K, Rizzo D, et al: Defining the intensity of conditioning regimens: working definitions. Biol Blood Marrow Transplant 15:1628, 2009.

Table 46-2 Retrospective Registry-Based Comparisons of NMA/RIC vs. Myeloablative Allogeneic Hematopoietic Stem Cell Tansplantation

ALL, Acute lymphoblastic leukemia; AML, acute myeloid leukemia; CIBMTR, Center for International Blood and Marrow Transplant Research; CLL, chronic lymphocytic leukemia; EBMT, European Group for Blood and Marrow Transplantation; HL, Hodgkin lymphoma; KPS, Karnofsky performance score; LFS, leukemia free survival; MAC, myeloablative conditioning; MDS, myelodysplastic syndrome; MM, multiple myeloma; MUD,