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Myeloablative conditioning for hematopoietic stem-cell transplantation in patients with non-malignant diseases

Bone Marrow Transplantation volume 38, pages 321–322 (2006)Cite this article

Although attractive, because of low early toxicity, reduced-conditioning HSCT may be associated with more problems in the long term. First, there may be an increased risk of graft failure. This may be especially pronounced in non-malignant diseases. Patients with hemoglobinopathies may be immunized by several previous blood transfusions. Indeed, Jacobsohn et al.6 also reported that only one of four patients with hemoglobinopathies had stable long-term engraftment. Furthermore, the use of peripheral blood stem cells may be unsuitable in non-malignant diseases because of the increased risk of extensive chronic graft-versus-host-disease (GVHD), compared to bone marrow as source of stem cells.8 Thus, 3/8 evaluable patients in the report by Jacobsohn et al.6 developed extensive chronic GVHD, of whom one died. In our experience of using bone marrow and myeloablative conditioning, none of 38 children observed more than 3 months with non-malignant disorders developed extensive chronic GVHD.

It has been argued that patients treated with reduced-intensity conditioning can be treated as outpatients. Isolation after HSCT may not be necessary, regardless of what conditioning is used. We showed that home care is safe for adult patients undergoing myeloablative conditioning for HSCT and results in lower transplantation-related mortality rates and better survival rates, compared with patients kept in isolation rooms in hospital.9

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  1. Division of Clinical Immunology, Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden

    O Ringdén, P Svenberg, K Le Blanc, J Mattsson & M Remberger

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  1. O Ringdén
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Ringdén, O., Svenberg, P., Le Blanc, K. et al. Myeloablative conditioning for hematopoietic stem-cell transplantation in patients with non-malignant diseases. Bone Marrow Transplant 38, 321–322 (2006). https://doi.org/10.1038/sj.bmt.1705438

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