TABLE 2-1 Indications for Allogeneic and Autologous Stem Cell Support

Disease

Allogeneic Transplantation

Autologous Transplantation

Leukemia (acute lymphoblastic, acute myelogenous, chronic myelogenous)

  • Effective

  • Controversial for acute lymphoblastic leukemia and chronic myelogenous leukemia

  • Acceptable for acute myelogenous leukemia

Lymphomas (Hodgkin’s disease, non-Hodgkin’s lymphoma)

  • Effective, but generally indicated only when autotransplantation is not possible or not effective because of higher toxicity

  • Effective

Myelodysplastic Syndromes

  • Given the high doses of chemo- or radiotherapy required, generally used on patients under 50.

  • Nonmyeloablative transplants are showing promise in older and/or weaker patients.

  • Effective, but only following chemotherapy. Generally used in patients under 50 years of age

Neuroblastoma (stage IV)

  • Controversial studies are ongoing to define role related to conventional therapy and autologous transplantation

  • Controversial; studies are ongoing to define the role related to conventional therapy and allogeneic transplantation

Bone and soft tissue sarcomas, Wilms’ tumor, brain tumors

  • Very rarely indicated

  • Rarely indicated and effectiveness unproven

Aplastic anemia and other cytopenias (not environmentally caused)

  • Effective

  • Not indicated

Immune deficiency (e.g., severe combined immunodeficiency disease)

  • Effective

  • Not indicated

Hemoglobinopathies, thalassemia, sickle cell anemia

  • Effective; controversial in unrelated subjects

  • Not indicated

Metabolic storage disorders, Hurler’s syndrome, metachromatic leukodystrophy

  • Controversial; may be effective in selected patients

  • Not indicated



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