HSCT recipient pretransplantation evaluation

All patients being considered for hematopoietic stem cell transplantation (HSCT) are required by federal (e.g., the FDA) and other regulatory agencies [e.g., Foundation for Accreditation of Cellular Therapy (FACT)] to undergo a pre-HSCT evaluation. The purpose of this evaluation is to ensure that the HSCT candidate is adequately “fit” enough to tolerate HSCT and to determine if the potential benefit from HSCT (i.e., a cure from a malignancy, halting the progression of a disorder, or replacement of a non- or dysfunctional immune system) outweighs the potential risks including death and short- and long-term debilitating side effects. To this end, organ function (e.g., liver, kidneys, heart, and lungs) and performance status are determined. Because HSCT recipients are profoundly immunocompromised and thus susceptible to life-threatening and opportunistic infections as well as reactivation of latent infections, all HSCT candidates undergo a thorough infection evaluation prior to the start of the conditioning regimen. All potential HSCT recipients also undergo restaging or reassessment of their disease state. The results of this evaluation along with the results of the other pre-HSCT testing are used to customize the patient’s conditioning regimen and supportive care plan in order to maximize the benefits while minimizing the morbidity of HSCT. This chapter details the components of this pre-HSCT recipient evaluation.