Eligibility assessment of a potential candidate for allogeneic hematopoietic cell transplantation (allo-HCT) is a complex yet vital component of pretransplant evaluation. Although no formal standardized consensus exists to guide this process, transplant centers follow institutional standard operating procedures and parameters to approve candidacy of an individual patient. Consideration for allo-HCT is dependent on a myriad of interrelated factors, including disease-related (eg, appropriate indication, disease status, prior therapies), patient-related (eg, age, functional status, frailty, comorbidities), psychosocial, and economic factors. A multidisciplinary approach is optimal for patient selection and requires the efforts of transplant coordinators, nurses, advanced practice providers, social workers, psychologists, financial specialists, and physicians. This article reviews the data and provides general guidelines that may be used in making an informed decision when evaluating a prospective candidate for allo-HCT. These recommendations are based on published data, expert commentary, reviews, and institutional practices. In the end, the eligibility assessment and decision to consider allo-HCT as the optimal choice of treatment for an individual patient are truly as much an “art” as it is the “science” of medicine, encompassing a multidisciplinary approach to minimize harm without compromising the curative potential—all essential doctrines of the Hippocratic Oath.
Submitted November 27, 2019; accepted for publication March 10, 2020.
Disclosures: Dr. Perales has disclosed that he has received support from NIH (award P01 CA23766) and NIH/NCI Cancer Center Support Grant (P30 CA008748); honoraria from Abbvie, Bellicum, Celgene, Bristol-Myers Squibb, Incyte, Merck, Novartis, Nektar Therapeutics, Omeros, and Takeda; serves as a scientific advisor for Cidara Therapeutics, Servier, and Medigene, MolMed, and NexImmune; and received grant/research support from Incyte, Kite/Gilead and Miltenyi Biotec. Dr. Hamadani has disclosed that he receives grant/research support from Takeda Pharmaceutical Company, Otsuka Pharmaceutical, Spectrum Pharmaceuticals, Astellas Pharma, Janssen R&D, Celgene Corporation, Merck, MedImmune, Seattle Genetics, and Millennium Pharmaceuticals; serves as a consultant for MedImmune LLC, Janssen R &D, Incyte Corporation, ADC Therapeutics, Cellerant Therapeutics, Celgene Corporation, Pharmacyclics & DOVA Oncology, Magenta Therapeutics, Omeros, and Verastem; and serves as a scientific advisor for Sanofi Genzyme, and AstraZeneca. Dr. Kanate has disclosed that he has no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors