Transplant Focus

Hematopoietic stem cell transplantation (HSCT) is a highly specialized and unique medical procedure. HSCT is a multi-step process that includes the collection of hematopoietic stem cells (HSCs) and the treatment of the patient with a conditioning regimen, followed by the infusion of HSCs and subsequent generation of a new hematopoietic and immune system.

This helps to enhance bone marrow function and allows the immune system to either destroy tumor cells or to generate functional cells that can replace the dysfunctional ones. Largely, HSCT can be divided into two types: autologous (auto-SCT), where a patients’ own HSCs are used, and the more elaborate and complex process of allogeneic HSCT (allo-SCT) where a patient receives the stem cell graft from a healthy donor. The indications for HSCT depend on the patient’s medical condition, the therapeutic aims, and the availability and source of HSCs.

According to the latest activity survey of the European Society of Blood and Marrow Transplantation (EBMT), 45,418 transplants were performed in 41,100 patients in 2017, of which 60% were autologous and 40% allogeneic. Regarding allo-SCT, acute myeloid leukemia is the most frequent indication (39%). The proportion of acute lymphocytic leukemia transplants has decreased only slightly, while other lymphoid malignancies have rather increased. For auto-SCT, plasma cell disorders are the most frequent indication (53%), of these 51.5% were for multiple myeloma. Proportions of auto-SCT for Hodgkin lymphoma (9%) and non-Hodgkin lymphoma (27%) have remained stable over the past 20 years.¹

Complications from HSCT, particularly allo-SCT, include graft-versus-host-disease (GvHD) and infection, which can be managed through prophylactic measures and treatment with immunoglobulins, corticosteroids, antibiotics and other supportive therapy.

Recent debates in the field of transplant include its evolving role in the management of hematological malignancies, alongside newer treatments such as CAR T-cell therapy and novel agents.

1. Passweg, J.R., Baldomero, H., Basak, G.W. et al. The EBMT activity survey report 2017: a focus on allogeneic HCT for nonmalignant indications and on the use of non-HCT cell therapies. Bone Marrow Transplant 54, 1575–1585 (2019)