Planning for Transplant

Establishing a treatment plan that incorporates the possibility of future hematopoietic cell transplant reduces risks that refractory disease, relapse, life-threatening infection or severe organ toxicity could prevent a patient from receiving a transplant when needed.

Transplant can be incorporated into the treatment plan when appropriate based on known risk factors for each disease, such as the International Prognostic Scoring System (IPSS) score for myelodysplastic syndromes, International Prognostic Index (IPI) for non-Hodgkin's lymphoma, and cytogenetic abnormalities for acute myelogenous leukemia, acute lymphocytic leukemia, and multiple myeloma. For more information, see Recommended Timing for Transplant Consultation.

Comprehensive treatment plan

• Assesses the patient's risk factors for the diagnosis and the treatment choices.
• Includes transplant as a potential therapy if and when indicated.
• Ensures treatments given do not preclude transplant — Toxicity from prior treatment can increase a patient's risk of post-transplant complications and affect outcomes.
• Enables a patient to move quickly to transplant, if needed, before disease progresses or complications develop. If allogeneic transplant is a possibility, tissue testing of the patient and any siblings is done early in the treatment process.
• Provides adequate time for an unrelated donor or cord blood search, if needed.

Consultation with a transplant physician can be useful in determining when to consider transplant, selecting first-line treatments that will not preclude transplant and planning when to type siblings or search for an unrelated donor or cord blood unit.

Transplant timing

• When the patient is in remission or has a small tumor burden
• When disease is sensitive to chemotherapy
• In patients with good performance status and normal organ function

Studies have shown that for many diseases, transplants performed early in the disease process are associated with lower risks of transplant-related mortality and disease recurrence. [1,2,3]

Transplant timing and treatment plan resources

• Recommended Timing for Transplant Consultation
• Transplant Outcomes by Disease and Disease Stage
• Preliminary Search Request Form

Resources for your patient

• Planning for Your Transplant
• When to Consider Transplant
• Discussing Options with Your Doctor

In addition, the NMDP has developed MatchView^SM, which allows patients to enter their HLA type to see the number of potential donors and cord blood units they may have on the NMDP Registry. Patients are encouraged to bring their results to their physician as a resource to discuss transplant as a treatment option.

Note: MatchView is not an alternative to a donor search conducted by a physician. For more information, see the MatchView Physician Information.

References

1. Lee SJ, Klein J, Haagenson M, et al. High-resolution donor-recipient HLA matching contributes to the success of unrelated donor marrow transplantation. Blood. 2007; E-pub ahead of print, Sept. 4.
   http://dx.doi.org/10.1182/blood-2007-06-097386
2. Cornelissen JJ, Carston M, Kollman, et al. Unrelated marrow transplantation for adult patients with poor-risk acute lymphoblastic leukemia: Strong graft-versus-leukemia effect and risk factors determining outcome. Blood. 2001; 97(6):1572-1577.
   http://www.bloodjournal.org/cgi/content/full/97/6/1572
3. McGlave PB, Shu XO, Wen W, et al. Unrelated donor marrow transplantation for chronic myelogenous leukemia: 9 years' experience of the National Marrow Donor Program. Blood. 2000; 95(7):2219-25.
   http://bloodjournal.hematologylibrary.org/cgi/content/full/95/7/2219