6 – 8 However, allogeneic PBPC transplants are associated with an increased risk of graft-versus-host disease (GVHD) compared with BM transplants. 5 Mobilization of peripheral blood progenitor cells (PBPCs) by granulocyte-colony stimulating factor has largely replaced use of BM grafts (in particular for autologous HCT) due to the ease of collection, avoidance of general anesthesia, more rapid engraftment rates, reduced risk of graft failure, and lower transplant-related mortality. Several clinical factors should be considered when determining the optimal graft source for an individual patient, including disease type, disease stage, patient comorbidities, and the urgency for transplantation. 2 Hematopoietic cells can be obtained from peripheral blood, BM, or umbilical cord blood (UCB). Outcomes of HCT vary according to the type and stage of the disease being treated, the overall health of the patient, the degree of HLA-mismatch between donor and recipient (for allogeneic HCT), and the source of the hematopoietic cells. 4 Acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), and myelodysplastic syndromes (MDS) were the most common malignancies treated with allogeneic HCT, while autologous HCT was used most frequently in multiple myeloma, non-Hodgkin lymphoma, and Hodgkin lymphoma. 3 The Center for International Blood and Marrow Transplant Research (CIBMTR) estimated that 9,028 allogeneic transplants and 14,709 autologous transplants were performed in the United States in 2018. The number of HCTs has increased in the United States in recent years. This is followed by rescue infusion of the patient’s own cells, which are harvested before high-dose therapy, to restore hematopoiesis and reconstitute the immune system. 1 In autologous HCT, high-dose myeloablative regimens are used to treat the malignancy. In allogeneic HCT, preparative regimens are administered to eradicate malignant cells in the bone marrow (BM if using myeloablative regimen) and induce immunosuppression so that engraftment of healthy donor cells occurs. Prior to HCT, most patients receive chemotherapy, serotherapy, and/or radiation for pretransplant conditioning (preparative regimen). An autologous HCT uses the patient’s own cells while an allogeneic HCT uses hematopoietic cells from a human leukocyte antigen (HLA)-compatible donor. HCT is classified as autologous or allogeneic based on the origin of hematopoietic cells. 1, 2 HCT is a potentially curative treatment option for patients with certain types of hematologic malignancies and is also used to support patients undergoing high-dose chemotherapy for the treatment of certain solid tumors. ![]() Hematopoietic cell transplantation (HCT) involves the infusion of hematopoietic progenitor cells into patients with malignant or nonmalignant hematologic disorders with the goal of re-establishing normal hematopoietic and immune function. The NCCN Guidelines for Hematopoietic Cell Transplantation focus on recommendations for pretransplant recipient evaluation and the management of GVHD in adult patients with malignant disease. Allogeneic HCT recipients may also develop acute and/or chronic graft-versus-host disease (GVHD), which results in immune-mediated cellular injury of several organs. Advances in HCT methods and supportive care in recent decades have led to improved survival after HCT however, disease relapse and posttransplant complications still commonly occur in both autologous and allogeneic HCT recipients. Allogeneic HCT is a potentially curative treatment option for patients with certain types of hematologic malignancies, and autologous HCT is primarily used to support patients undergoing high-dose chemotherapy. ![]() Autologous HCT uses the patient’s own cells while allogeneic HCT uses hematopoietic cells from a human leukocyte antigen-compatible donor. Hematopoietic cell transplantation (HCT) involves the infusion of hematopoietic progenitor cells into patients with hematologic disorders with the goal of re-establishing normal hematopoietic and immune function.
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