Indications for transplantation
| Disease . | Timing of/indication for HCT . |
|---|---|
| Acute myeloid leukemia | |
| NPM1+ Flt3−; Inv(16) or t(8;21) plus c-kit− | Beyond first CR |
| All others | First CR |
| Acute lymphoblastic leukemia | |
| Ph+; complex karyotype; t(4;11), t(1;19); high WBC; time to CR > 4 wk | First CR |
| Others | Beyond first CR |
| Myelodysplastic syndrome | ≥ 5% myeloblasts; high-risk karyotype |
| Multiple myeloma | < 60 years of age with high-risk cytogenetics: hypodiploid; deletion chromosome 13 or 17; t(4;14); t(14;16); β2m > 5.5 (stage III) |
| Non-Hodgkin lymphoma | Relapse after autologous HCT; large cell, relapsing from chemotherapy-induced remission; transformation from follicular, not responding to chemotherapy; autologous followed by RIC allogeneic HCT; mantle cell, possibly in first CR |
| Myeloproliferative neoplasms | Peripheral blood cytopenia; leukemic transformation |
| Aplastic anemia | |
| HLA-identical sibling available | As initial therapy |
| Alternative donor | Failure of sustained response to immunosuppressive therapy |
| Disease . | Timing of/indication for HCT . |
|---|---|
| Acute myeloid leukemia | |
| NPM1+ Flt3−; Inv(16) or t(8;21) plus c-kit− | Beyond first CR |
| All others | First CR |
| Acute lymphoblastic leukemia | |
| Ph+; complex karyotype; t(4;11), t(1;19); high WBC; time to CR > 4 wk | First CR |
| Others | Beyond first CR |
| Myelodysplastic syndrome | ≥ 5% myeloblasts; high-risk karyotype |
| Multiple myeloma | < 60 years of age with high-risk cytogenetics: hypodiploid; deletion chromosome 13 or 17; t(4;14); t(14;16); β2m > 5.5 (stage III) |
| Non-Hodgkin lymphoma | Relapse after autologous HCT; large cell, relapsing from chemotherapy-induced remission; transformation from follicular, not responding to chemotherapy; autologous followed by RIC allogeneic HCT; mantle cell, possibly in first CR |
| Myeloproliferative neoplasms | Peripheral blood cytopenia; leukemic transformation |
| Aplastic anemia | |
| HLA-identical sibling available | As initial therapy |
| Alternative donor | Failure of sustained response to immunosuppressive therapy |
This list provides disease-based recommendations; in addition, the patient's comorbidities and performance status among other factors must be considered.
WBC indicates white blood cell count; CR, complete remission; and RIC, reduced-intensity conditioning regimen.