Bone Marrow Transplant Center And Hematology

Scope

Although most marrow transplants are for hematologic malignancies, the most common indications for allogeneic and autologous transplants differ:

( 1 ) Allogeneic BTM

Allorafts are indicated for some congenital abnormalities of bone marrow function or where there is disease involving the marrow not amenable to cure with standard treatment:
A) Indications of allogeneic BMT
  • chronic myeloid leukemia (in chronic phase) 
  • Acute myeloid leukemia:
    • All patients in first complete remission except Favorable stagnates risk group. 

    • All patients with relapsed or refractory AML.

  • Acute lymphoblastic leukemia: adult ALL pediatric in first or second complete remission  (according to risk stratification).
  • High-risk patients in first complete remission (CR1)
  • Low-risk patients in second complete remission (CR2).
  • Severe aplastic anemia (up to 40 years of age) including paroxysmal nocturnal hemoglobinuria.
  • Hemoglobinopathies:
    • B- thalassemia major.
    • Sickle all disease fulfiling the international criteria for BMT.
  • Myelodysplastic syndromes: All FAB classification.
  • Chronic lymphocytic leukemia.
  • Lymphoma (both NHL HD):beyond first CR unsuitable for autografting and>40 years of age.
  • Fanconi anemia.
  • Acute myeloid leukemia:
  • chronic myeloid leukemia CML adult type: in first chronic phase
  • Juvenile CML/MDS
  • Congenital immunodeficiency.
  • Inborn errors of metablism.  

 ( 2 )Autologous BMT       
Since a marrow or stem cell source for allografting can not always be found, autologous stem cell transplantation (ASCT) is also used as a method for treating a number of malignant disorders as:
 A) indications of autologous BMT in adults (age ≤ 60 years):

  • Lymphoma (both NHL & HD):

    • Patients in 2nd complete remission or beyond.

    • High-risk patients (according to IPI) in first CR.

  • Multiple myeloma: all patients achieved CR or VGPR

  • Chronic lymphocytic leukemia: high-risk patients indicated for non-myeloablative allogeneic BMT having no suitable donor.
B) Indications of autologous BMT in children:

  • Hodgkin.s disease:

    • Primary refractory

    • Relapsing

  • Non-Hodgkin’s lymphoma:

    • In second complete remission (CR2).

    • Primary refractory.

  • Neuroblastoma (high-risk):

    • Complete remission

    • Very good partial remission.