Hematopoietic Cell Transplantation, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology

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Abstract

Hematopoietic cell transplantation (HCT) involves the infusion of hematopoietic progenitor cells into patients with hematologic disorders with the goal of re-establishing normal hematopoietic and immune function. HCT is classified as autologous or allogeneic based on the origin of hematopoietic cells. Autologous HCT uses the patient’s own cells while allogeneic HCT uses hematopoietic cells from a human leukocyte antigen-compatible donor. Allogeneic HCT is a potentially curative treatment option for patients with certain types of hematologic malignancies, and autologous HCT is primarily used to support patients undergoing high-dose chemotherapy. Advances in HCT methods and supportive care in recent decades have led to improved survival after HCT; however, disease relapse and posttransplant complications still commonly occur in both autologous and allogeneic HCT recipients. Allogeneic HCT recipients may also develop acute and/or chronic graft-versus-host disease (GVHD), which results in immune-mediated cellular injury of several organs. The NCCN Guidelines for Hematopoietic Cell Transplantation focus on recommendations for pretransplant recipient evaluation and the management of GVHD in adult patients with malignant disease.

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National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group report.

Madan H Jagasia, Hildegard T Greinix, Mukta Arora … (2015)

The 2005 National Institutes of Health (NIH) Consensus Conference proposed new criteria for diagnosing and scoring the severity of chronic graft-versus-host disease (GVHD). The 2014 NIH consensus maintains the framework of the prior consensus with further refinement based on new evidence. Revisions have been made to address areas of controversy or confusion, such as the overlap chronic GVHD subcategory and the distinction between active disease and past tissue damage. Diagnostic criteria for involvement of mouth, eyes, genitalia, and lungs have been revised. Categories of chronic GVHD should be defined in ways that indicate prognosis, guide treatment, and define eligibility for clinical trials. Revisions have been made to focus attention on the causes of organ-specific abnormalities. Attribution of organ-specific abnormalities to chronic GVHD has been addressed. This paradigm shift provides greater specificity and more accurately measures the global burden of disease attributed to GVHD, and it will facilitate biomarker association studies.

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Acute Graft-versus-Host Disease — Biologic Process, Prevention, and Therapy

Dan L Longo, Robert Zeiser, Bruce R. Blazar (2017)

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Reduced mortality after allogeneic hematopoietic-cell transplantation.

Ted Gooley, Jason Chien, Steven A Pergam … (2010)

Over the past decade, advances have been made in the care of patients undergoing transplantation. We conducted a study to determine whether these advances have improved the outcomes of transplantation. We analyzed overall mortality, mortality not preceded by relapse, recurrent malignant conditions, and the frequency and severity of major complications of transplantation, including graft-versus-host disease (GVHD) and hepatic, renal, pulmonary, and infectious complications, among 1418 patients who received their first allogeneic transplants at our center in Seattle in the period from 1993 through 1997 and among 1148 patients who received their first allogeneic transplants in the period from 2003 through 2007. Components of the Pretransplant Assessment of Mortality (PAM) score were used in regression models to adjust for the severity of illness at the time of transplantation. In the 2003-2007 period, as compared with the 1993-1997 period, we observed significant decreases in mortality not preceded by relapse, both at day 200 (by 60%) and overall (by 52%), the rate of relapse or progression of a malignant condition (by 21%), and overall mortality (by 41%), after adjustment for components of the PAM score. The results were similar when the analyses were limited to patients who received myeloablative conditioning therapy. We also found significant decreases in the risk of severe GVHD; disease caused by viral, bacterial, and fungal infections; and damage to the liver, kidneys, and lungs. We found a substantial reduction in the hazard of death related to allogeneic hematopoietic-cell transplantation, as well as increased long-term survival, over the past decade. Improved outcomes appear to be related to reductions in organ damage, infection, and severe acute GVHD. (Funded by the National Institutes of Health.).

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Author and article information

Journal

Title: Journal of the National Comprehensive Cancer Network

Publisher: Harborside Press, LLC

ISSN (Print): 1540-1405

ISSN (Electronic): 1540-1413

Publication date Created: May 2020

Publication date (Print): May 2020

Volume: 18

Issue: 5

Pages: 599-634

Affiliations

[1 ]1The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute;

[2 ]2Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute;

[3 ]3University of Michigan Rogel Cancer Center;

[4 ]4Fred & Pamela Buffett Cancer Center;

[5 ]5Moffitt Cancer Center;

[6 ]6Roswell Park Comprehensive Cancer Center;

[7 ]7Huntsman Cancer Institute at the University of Utah;

[8 ]8O'Neal Comprehensive Cancer Center at UAB;

[9 ]9Massachusetts General Hospital Cancer Center;

[10 ]10Memorial Sloan Kettering Cancer Center;

[11 ]11University of Colorado Cancer Center;

[12 ]12Dana-Farber/Brigham and Women's Cancer Center;

[13 ]13Duke Cancer Institute;

[14 ]14Stanford Cancer Institute;

[15 ]15University of Wisconsin Carbone Cancer Center;

[16 ]16Mayo Clinic Cancer Center;

[17 ]18The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins;

[18 ]19Fred Hutchinson Cancer Research Center/ Seattle Cancer Care Alliance;

[19 ]20Robert H. Lurie Comprehensive Cancer Center of Northwestern University;

[20 ]21City of Hope National Medical Center;

[21 ]22The University of Texas MD Anderson Cancer Center;

[22 ]23Vanderbilt-Ingram Cancer Center;

[23 ]24Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine;

[24 ]25Fox Chase Cancer Center;

[25 ]26UC San Diego Moores Cancer Center; and

[26 ]27National Comprehensive Cancer Network

Article

DOI: 10.6004/jnccn.2020.0021

PubMed ID: 32519831

SO-VID: f1235391-1f24-485e-8e87-bba267c85353

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