Evaluation of the pretransplantation phase of the hemopoietic stem cell program in a tertiary hospital.
BACKGROUND
Therapeutic decisions and clinical events during the pretransplantation phase of stem cell transplantation (SCT) may influence survival, quality of life, and efficiency of health expenses. However, there is a lack of relevant published data.


OBJECTIVE
The aims of this study were to identify reasons why the procedure was not performed and to know the waiting time for SCT candidates.


METHODS
We collected pretransplantation data from 166 consecutive patients evaluated by the SCT Committee of a tertiary center between April 2005 and December 2006.


RESULTS
One hundred fifty-two of 166 patients were referred for the first time. Additionally, 14 were reconsidered as candidates for a subsequent SCT due to relapse, graft failure, secondary malignancy, or a multiple-graft program. One hundred forty-one were accepted for transplantation, whereas 25 were not. At the time of analysis, 22 patients were still awaiting SCT, 8 were delayed because they required additional courses of treatment, and 32 were excluded because of death (34.4%), poor stem cell mobilization (21.9%), patient refusal (15.6%), relapse/progression (9.4%), comorbidity (6.3%), or absence of a donor (6.3%). The median time between inclusion in the program and transplantation was 3.6 months (range, 0.27-13.43), and 5.7 months (P < .05) for unrelated allogeneic transplantation. No significant differences were observed in the diagnosis or hospital of origin.


CONCLUSIONS
SCT was not performed in 22% of transplant candidates, mainly due to death, insufficient stem cell mobilization, patient refusal, or disease progression/relapse. The median time between inclusion in the SCT program and transplantation was 3 months, but longer among the unrelated allogeneic transplantations.
Márquez Malaver
F J
FJ
Servicio de Hematología y Hemoterapia, Hospital Universitario Virgen del Rocío, Seville, Spain. fjose.marquez.sspa@juntadeandalucia.es
Espigado Tocino
I
I
Balsalobre López
P
P
Carmona González
M
M
Parody Ruiz-Berdejo
R
R
Perez-Hurtado de Mendoza
J M
JM
Urbano Ispizua
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery*; D018579:Patient Selection; D011788:Quality of Life; D013030:Spain; D014019:Tissue Donors / Q000706:statistics & numerical data; D014184:Transplantation, Homologous / Q000379:methods / Q000706:statistics & numerical data; D055815:Young Adult