For decades transplantation clinicians have used age in decisions about candidacy for hematopoietic cell transplantation (HCT) It has often been joked that as transplanters have aged the “acceptable” age for HCT has increased. It has been assumed that age is a surrogate for likelihood for transplantation morbidity and mortality.
The American Society for Blood and Marrow Transplantation (ASBMT) has supported the conduct of a series of evidence-based reviews exploring the role of hematopoietic cell transplantation (HCT) in various hematologic disorders over the past several years. This abridged report summarizes the major findings of two recent reviews addressing the role of HCT in the management of acute lymphoblastic leukemia, one review in children, the other in adults.
The three prime ingredients of allogeneic hematopoietic cell transplantation (HCT) are conditioning regimen, graft, and posttransplantation supportive care. For decades, much of the research interest has focused on the latter two ingredients. Characterization of graft hematopoietic and immune constituents and manipulation of these elements have led to important insights, new knowledge, and improved outcomes.
The remarkable early success of G-CSF in effective stem cell mobilization was both surprising and fortuitous. Only years later do we have a good (yet still incomplete) idea of why and how it happens.
With so much success in controlling cytomegalovirus (CMV) disease, one feels almost ungrateful to furtively whisper that there is more yet to do. Still, there is the inconvenience and expense of intravenous regimens, there are toxicity issues with current regimens, and we still face late CMV disease, which is growing in frequency.
Try as hard as it can, the myelodysplastic bone marrow just cannot seem to meet the ordinary day-to-day needs for blood cells. Indeed, failure is destined no matter what we do. Then, when it seems as bad as it can get, it only gets worse: total marrow shutdown or change into leukemia. Effective therapy has been long overdue.