Bone Marrow Transplantation in NCCN v.1.2002 Guidelines

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AML, CML, Myeloma

 

Acute Myelocytic Leukemia (age < 60):

 

HLA typing and marrow cytogenetics at diagnosis

 

Allo BMT with matched sibling or alternative donor

-any induction failure

-in first remission if other than best risk cytogenetics or antecedent hematologic disorder

-at relapse

 

 

Chronic Myelogenous Leukemia (“if eligible for BMT”):

 

HLA typing and marrow cytogenetics at diagnosis

 

Allo BMT with matched sibling or alternative donor

-any cytogenetics other than simple Ph¹ or Ph¹ neg patients who are BCR-ABL pos

-Ph¹ pos patients after stabilization of WBC and platelets with hydrea and/or anegrelide and after consultation and discussion of all options with the patient

 

Note: “BMT and IFN+/-cytarabine (indicated for non BMT candidates or refusal)

have definite survival benefits whereas, despite very promising early responses,

the survival benefit, long term toxicities and durability of response of imatimib

mesylate (STI541/Gleevec) are unknown.”

 

 

Multiple Myeloma (age < 60, stage > 1):

 

HLA typing and myeloma cell cytogenetics at diagnosis

 

Stem cell harvest

-responding to, or stable on, initial conventional dose chemotherapy if not proceeding to allo BMT

 

Auto or Allo BMT

-responding to, or stable on, initial induction chemotherapy after consultation and discussion of all options with the patient

-after salvage therapy for recurrent or progressive disease

 

 

 

 

 

Bone Marrow Transplantation in NCCN v.1.2002 Guidelines

MDS, HD,NHL

 

Myelodysplastic Syndromes:

 

                               HLA typing and marrow cytogenetics at diagnosis

 

Allo BMT

-        stage INT-1, age <60 or good performance status

-        stage INT-2, any age subject to institutional limits

 

 

Hodgkin's Disease:

 

Auto BMT

-        partial remission or progressive disease after initial chemotherapy

-        after salvage therapy for relapse after first chemotherapy induced remission

especially for disease free interval <1 year

 

 

Follicular Lymphoma and some CLL:

 

Auto or Allo BMT

-        after salvage therapy for first relapse especially if CR or PR

-        in CR or PR after salvage therapy for any transformation

 

 

Nongastric MALT Lymphoma:

 

Follow guideline for follicular lymphoma if low grade or diffuse large B-cell if high grade

 

 

Mantel cell Lymphoma:

 

Note:  "HDT with autologous or allogeneic source of stem cells is an active area of

investigation"

 

 

Diffuse Large B-cell Lymphoma:

 

Auto or Allo BMT

PR or CR after first relapse or PR after initial combination chemotherapy