An allogeneic stem cell transplantation with myeloablative conditioning facilitates maximization of treatment with chemotherapy, perhaps in combination with total body radiation. The treatment involves removal of the patient's bone marrow and replacing it with new bone marrow from a donor with compatible tissue. Additionally, an immunological effect is often achieved directed toward the remaining leukemia cells. Hematopoetic stem cells are transferred from an individual who is normally tissue-identical but genetically different from the patient.
The patient should not have a serious, complicated disease and there must be an appropriate donor. Using a family donor, a transplantation with myeloablative conditioning is appropriate for patients under 60 years. Unrelated, HLA-identical donors are suitable for certain patients below 55-60 years. It is important to take into consideration the patient's biological age. If it is possible to choose between multiple donors, it is preferred that the donor is of the same sex as the patient. If possible, a CMV negative donor is preferred if the patient is CMV negative.
The treatment can cure otherwise incurable blood diseases, but its intensity is associated with many side effects. There is also a risk of fatal complications.
- Acute myeloid leukemia (AML)
- After recurrence, in the beginning of the first recurrence or in later, preferably second remission.
- In the first remission for patients who do not have a low risk for recurrence, if the patient is under 60 years and there is a family donor.
- Patients under 55-60 years with high risk for recurrence with unrelated suitable donor, in the first remission.
- Acute lymphoblastic leukemia (ALL)
- In the first remission with high risk criteria and for new remission after first recurrence.
- Chronic myeloid leukemia leukemia (CML)
- In the chronic phase with poor or no response of tyrosine kinase inhibitors or in accelerated phase.
- Multiple myeloma
- Younger patients with good response to primary treatment and with a suitable family donor. At the present time, the indication is debated.
- Serious aplastic anemia, myelodysplastic syndrome, primary myelofibrosis, chronic myelomonocyte leukemia, and other rare diseases.