Autologous hematopoietic cell transplantation: An update for clinicians

Advances in supportive care have dramatically improved the safety of autologous transplantation in the modern era, with expected rates of treatment-related mortality below 2% -3%.Peripheral blood has replaced bone marrow as the preferred source of stem cells.Autologous transplantation is the standard of care and potentially curative option for patients with relapsed Hodgkin and aggressive B-cell lymphomas.Autologous transplant survivors require meticulous follow-up from primary care physicians to screen for long-term complications.High-dose chemotherapy followed by transplantation of autologous hematopoietic progenitor cells has a proven track record of safety and effi cacy in hematological malignancies and select solid tumors.The near-universal use of peripheral blood stem cells as source for autografts, routine growth factor support, and antimicrobial prophylaxis post transplantation has improved the safety of this procedure.However, the advent of highly active novel therapies in the last few years warrants reappraisal of the role of autologous transplantation in the therapeutic armamentarium of malignant disorder.This review summarizes the current role of autologous transplantation for hematological malignancies, discusses modern standards for patient selection, and highlights long-term care issues of transplant survivors from an internist ' s perspective.Role of tumor purging in autologous transplantation, novel transplant conditioning regimens, and post-transplant therapies to prevent disease relapse are reviewed.