Abstract
Blood and marrow transplantation (BMT) has evolved over the years and is indicated when transplant offers better survival as compared to nontransplant therapy. Due to the risks of transplant related mortality, BMT is only undertaken after comprehensive risk assessment and after appropriate counseling with the patient.The most common indications for allogeneic hematopoietic cell transplantation (HCT) are the hematological malignancies, like AML, ALL, MDS, myelofibrosis, and CLL, while for autologous HCT the commonest indications are multiple myeloma and lymphomas. Transplantation is offered to high-risk malignancies, and indications change as alternative therapies offer safer and better outcomes. CLL has seen major treatment changes as novel agents have been approved; however, transplant continues to remain the sole curative option. The use of autologous transplant in lymphomas has traditionally been used in the relapsed/refractory setting in patients with chemo-sensitive disease. In certain subtypes such as mantle cell lymphomas, autologous transplants are used upfront as consolidation therapy. Allogeneic transplants are generally reserved for lymphoma patients who experience relapse or have refractory disease.For nonmalignant disorders like aplastic anemia, BMT is indicated in high risk disease or when there is no response to immune-modulation. In hemoglobin disorders (thalassemias and sickle cell disease), allogeneic BMT offers cure, at the cost of risk of early transplant related mortality. Certain indications are uncommon, such as autologous transplantation for autoimmune disorders like multiple sclerosis and Crohn’s disease and BMT for select solid tumors.The results of HCT are improving, with better pretransplant conditioning and management of complications. The use of related haplo-identical donors has increased the options of BMT to patients who do not have a matched sibling or unrelated donor.KeywordsBone marrow transplantation (BMT)Hematopoietic cell transplantation (HCT)Graft-versus-host disease (GVHD)AMLALLMDSHodgkin lymphomaNHLAplastic anemiaHemoglobinopathies
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