
General Principles for Making Transplant Decisions
Although broad guidelines can be provided, the decision to recommend a Stem Cell Transplant (SCT) for any individual patient will reflect many factors, some of them unique to that person.
The likely effect of the SCT needs to be balanced against the likely outcome of any available non-transplant treatments.
Key factors to establish are:
- The exact diagnosis and any additional good or bad prognostic features.
- What co-morbidities are present and what is their severity?
- What is the performance status?
- What is the patient's chronological age?
- What does the patient want?
Based on this information:
- What is the prognosis using non-transplant treatments?
- What is the prospect of a transplant-based therapy being superior to other modalities?
- What type of transplant should be recommended?
- Allogeneic or autologous?
- Donor source - sibling or unrelated?
- Conditioning - conventional myeloablative, reduced intensity or non-myeloablative?
Information Sources Helpful in Making Transplant Decisions
National and international guidelines exist, but are difficult to keep up-to-date, as this is such a rapidly changing field. Decisions will also be influenced by the introduction of non-transplant based treatments (e.g., Imatinib).
Useful sources on information in a hierarchical evidence-based system are:
- Meta-analyses of randomised controlled trials
- Randomised controlled trials
- Retrospective analyses of very large databases, e.g. CIBMTR, EBMT, IFM
- Systematic reviews and expert opinions, e.g. “How I treat” series in Blood
- Non-randomised retrospective cohort studies
- Overseas opinions
Topic Code: 8140