Recommended screening and preventive evaluation practices of adult candidates for hematopoietic stem cell transplantation

INTRODUCTION: Hematopoietic stem cell transplantation (HSCT) is associated with a substantial risk of morbidity and mortality. Better selection of HSCT patients for intensive treatment, and consequently reduction of non-beneficial care, may improve the therapeutic outcome. AREAS COVERED: This manuscript provides a systematic review which examines t he current criteria for selection of HSCT patients. EXPERT OPINION: Identifying patients who may benefit from HSCT involves many factors, including overall health, prior therapies, age, disease, and stage. The decision regarding transplant eligibility should be made on a case by case basis, based on a risk-benefit assessment. The advent of the comorbidity index as a measure of health status at the time of HSCT has facilitated the incorporation of comorbidities into the pre-transplant assessment of patients. Many HSCT protocols are still age-dependent, with criteria limited to patients either younger or older than arbitrary age cut-offs.The prognostic role of age in the transplant setting has never been consistent. As physicians and researchers continue improving the HSCT process and outcomes, optimization of the delivery of a comprehensive treatment plan should become an important component of overall patient management.