During the transplant evaluation process, potential recipients undergo physical and psychological assessments to determine eligibility for transplantation.⁷ The transplant physician considers the individual's disease, risk factors, and reported survival data to determine appropriate disease management. 

Factors that improve outcomes

Refinements in criteria for performing HSCTs have improved outcomes. Both disease and individual factors have been recognised as significant in minimising the risk of failure from toxicity and improving control of underlying disease.¹³

Disease factors associated with improved outcomes include:¹³

• transplantation in individuals with chemotherapy-induced remission
• transplantation earlier in the course of the disease.

Australian ten-year survival probability data reinforce this. Recipients aged over 16 who received their first allogeneic related transplant in their first remission have a survival probability of 56%. Recipients with poor risk have a survival probability of 29%.²

Factors that increase risk

Individual factors that increase the risk associated with HSCT include:¹³

• advanced age of the individual
• significantly impaired ventilatory function
• abnormal hepatic function
• abnormal renal function
• presence of an active infection.

Potential autologous transplant recipients should have limited exposure to myelotoxic agents to avoid compromising stem-cell reserve prior to stem cell harvest.¹⁴

Learning activities

Next: Bone marrow registries [2]