For those who did not practice hematopoietic cell transplantation (HCT) at the time, it may be difficult to appreciate the impact that mobilized peripheral blood stem cells (PBSC) have had on the pace of hematologic recovery. In the days before mobilized PBSC, count recovery before day +21 was uncommon, and prolonged neutropenia resulted in a risk of death from infection that exceeded 5%.
The management of mantle cell lymphoma and T-cell lymphoma remains a challenge for many oncologists. Unlike the more common follicular or diffuse-large B-cell lymphomas, there is a paucity of prospective controlled trials, and there are no standards for the management of these diseases. Practice patterns can vary considerably from center to center.
The treatment of acute myelogenous leukemia (AML) has 2 steps: the first step involves therapy to get it into remission, and the second step involves therapy to prevent it from coming back. Over several decades our approach to the first step has largely remained the same, but our approach to the second step has evolved significantly. The fundamental clinical decision for the second step has become: is the prospect for durable control better with posttransplantation chemotherapy or with hematopoietic cell transplantation?
Heterogeneous in nature the management of leukemia, lymphoma and multiple myeloma all present complex clinical problems, requiring an ever evolving multidisciplinary approach to diagnosis and treatment. Recognizing that patient quality of life and survival are significantly improved when these cancers are detected early and treated appropriately.
In the late 1990s, the use of reduced-intensity conditioning regimen (RIC) was a major paradigm shift in the field of stem cell transplantation. The main idea was to harness the graft-versus-tumor (GVT) effect to achieve the ultimate goal of cure without the need for toxic myeloablative therapy. It became clear that engraftment after RIC can result in mixed donor chimerism adequate to correct the medical problem without subjecting the patient to short- and long-term toxicities associated with myeloablative transplantation regimens.