Autologous stem cell transplantation

Abstract

Autologous stem cell transplantation (ASCT) is a treatment strategy that allows for the administration of higher than usual doses of myelotoxic chemotherapy and/or radiation therapy to treat several hematologic and nonhematologic malignancies. High-dose chemotherapy (HDT) with ASCT is widely performed in HIV-negative patients with Hodgkin (HL) and non-Hodgkin lymphoma (NHL) and is standard therapy for refractory and relapsed patients, based on results of phase III trials. It is also used as part of initial therapy for aggressive NHL, particularly in patients with poor prognostic factors at diagnosis. In earlier eras, this treatment approach has been considered prohibitive in HIV-positive patients, because of the potential toxicity and risk of worsening immune function, thereby accelerating the course of HIV infection. The introduction of combination antiretroviral therapy (cART) in the mid-1990s has led to improvement of immune function and reduced morbidity of HIV-infected patients, thus allowing more aggressive treatment strategies including HDT and ASCT in cART-treated patients. Moreover, the use of peripheral blood stem cells instead of bone marrow significantly shortens the time to engraftment after HDT and has helped to further reduce transplant-related morbidity and mortality.