{"entity":{"id":"autologous-stem-cell-transplant","kind":"technology","name":"Autologous stem cell transplant (high-dose therapy)","aka":[],"tldr":"Autologous stem cell transplant collects the patient's own blood-forming stem cells, gives melphalan or another chemotherapy at a dose that would otherwise destroy the marrow, then returns the cells to rebuild it. It is standard consolidation in myeloma and for relapsed lymphoma, though CAR-T has displaced it in early-relapsing large B-cell lymphoma.","summary":"High-dose melphalan with autologous stem-cell rescue has been the consolidation standard in transplant-eligible myeloma since the 1990s (IFM 90, Attal 1996) and remains so in the quadruplet era (PERSEUS, IFM 2009/DETERMINATION show PFS but not OS benefit over continued triplet therapy). In lymphoma it is the standard salvage consolidation for chemosensitive late relapse (PARMA) and for relapsed Hodgkin lymphoma; CAR-T has displaced it for early-relapsing LBCL. Tandem (two sequential) transplants are used in high-risk neuroblastoma.","status":"standard-of-care","asOf":"2026-09-07","wikipedia":"https://en.wikipedia.org/wiki/Hematopoietic_stem_cell_transplantation","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Hematopoietic_stem_cell_transplantation"}],"tags":[],"related":[],"cancers":["multiple-myeloma","dlbcl","hodgkin-lymphoma","neuroblastoma"],"sections":["chemotherapy","cell-therapy"],"technologies":["cytotoxic-chemotherapy"],"targets":[],"drugs":["defibrotide"],"companies":["angiocrine-bioscience"],"institutions":[],"pathways":[],"terms":["mrd"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":["apheresis-starting-material","cell-therapy-cold-chain"],"notes":[],"principle":"Peripheral blood stem cells mobilised (G-CSF ± plerixafor), collected by apheresis, cryopreserved; myeloablative conditioning (melphalan 200 mg/m2 in myeloma; BEAM in lymphoma; busulfan-melphalan or carboplatin-etoposide-melphalan in neuroblastoma); reinfusion; engraftment in ~2 weeks.","strengths":["Permits dose intensity impossible otherwise","Decades of outcome data","Widely available"],"limitations":["Treatment-related mortality ~1-2% (myeloma) to higher in children","Infertility, second malignancies, prolonged cytopenias","Being challenged by CAR-T and MRD-guided deferral"],"since":1983},"route":"/technologies/autologous-stem-cell-transplant/","neighbours":{"cancer":[{"id":"apl","kind":"cancer","name":"Acute promyelocytic leukaemia","route":"/cancers/apl/"},{"id":"alk-negative-anaplastic-large-cell-lymphoma","kind":"cancer","name":"ALK-negative anaplastic large cell lymphoma","route":"/cancers/alk-negative-anaplastic-large-cell-lymphoma/"},{"id":"atrt","kind":"cancer","name":"Atypical teratoid/rhabdoid tumour (ATRT)","route":"/cancers/atrt/"},{"id":"bpdcn","kind":"cancer","name":"Blastic plasmacytoid dendritic cell neoplasm (BPDCN)","route":"/cancers/bpdcn/"},{"id":"burkitt-lymphoma","kind":"cancer","name":"Burkitt lymphoma","route":"/cancers/burkitt-lymphoma/"},{"id":"cns-germ-cell-tumours","kind":"cancer","name":"Central nervous system germ cell tumours (germinoma and non-germinomatous)","route":"/cancers/cns-germ-cell-tumours/"},{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"enteropathy-associated-t-cell-lymphoma","kind":"cancer","name":"Enteropathy-associated T-cell lymphoma","route":"/cancers/enteropathy-associated-t-cell-lymphoma/"},{"id":"ewing-sarcoma","kind":"cancer","name":"Ewing sarcoma","route":"/cancers/ewing-sarcoma/"},{"id":"extragonadal-germ-cell-tumour","kind":"cancer","name":"Extragonadal germ cell tumour","route":"/cancers/extragonadal-germ-cell-tumour/"},{"id":"follicular-lymphoma","kind":"cancer","name":"Follicular lymphoma","route":"/cancers/follicular-lymphoma/"},{"id":"paediatric-germ-cell-tumours","kind":"cancer","name":"Germ cell tumours of childhood and adolescence (extracranial and CNS)","route":"/cancers/paediatric-germ-cell-tumours/"},{"id":"gestational-trophoblastic","kind":"cancer","name":"Gestational trophoblastic neoplasia","route":"/cancers/gestational-trophoblastic/"},{"id":"medulloblastoma-group-3-4","kind":"cancer","name":"Group 3 and group 4 medulloblastoma (non-WNT/non-SHH)","route":"/cancers/medulloblastoma-group-3-4/"},{"id":"high-risk-gtn","kind":"cancer","name":"High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk)","route":"/cancers/high-risk-gtn/"},{"id":"neuroblastoma-high-risk","kind":"cancer","name":"High-risk neuroblastoma","route":"/cancers/neuroblastoma-high-risk/"},{"id":"hiv-associated-lymphoma","kind":"cancer","name":"HIV-associated (AIDS-related) lymphomas","route":"/cancers/hiv-associated-lymphoma/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"},{"id":"mantle-cell-lymphoma","kind":"cancer","name":"Mantle cell lymphoma","route":"/cancers/mantle-cell-lymphoma/"},{"id":"medulloblastoma","kind":"cancer","name":"Medulloblastoma","route":"/cancers/medulloblastoma/"},{"id":"multiple-myeloma","kind":"cancer","name":"Multiple myeloma","route":"/cancers/multiple-myeloma/"},{"id":"neuroblastoma","kind":"cancer","name":"Neuroblastoma (paediatric)","route":"/cancers/neuroblastoma/"},{"id":"myeloma-transplant-eligible","kind":"cancer","name":"Newly diagnosed multiple myeloma, transplant-eligible","route":"/cancers/myeloma-transplant-eligible/"},{"id":"angioimmunoblastic-t-cell-lymphoma","kind":"cancer","name":"Nodal T-follicular helper cell lymphoma, angioimmunoblastic type (angioimmunoblastic T-cell lymphoma)","route":"/cancers/angioimmunoblastic-t-cell-lymphoma/"},{"id":"nodular-lymphocyte-predominant-hodgkin-lymphoma","kind":"cancer","name":"Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma)","route":"/cancers/nodular-lymphocyte-predominant-hodgkin-lymphoma/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"},{"id":"non-seminoma","kind":"cancer","name":"Non-seminomatous germ cell tumour","route":"/cancers/non-seminoma/"},{"id":"peripheral-t-cell-lymphoma","kind":"cancer","name":"Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)","route":"/cancers/peripheral-t-cell-lymphoma/"},{"id":"placental-site-trophoblastic-tumour","kind":"cancer","name":"Placental-site trophoblastic tumour and epithelioid trophoblastic tumour","route":"/cancers/placental-site-trophoblastic-tumour/"},{"id":"plasma-cell-leukaemia","kind":"cancer","name":"Plasma cell leukaemia","route":"/cancers/plasma-cell-leukaemia/"},{"id":"primary-cns-lymphoma","kind":"cancer","name":"Primary CNS lymphoma","route":"/cancers/primary-cns-lymphoma/"},{"id":"primary-testicular-lymphoma","kind":"cancer","name":"Primary large B-cell lymphoma of the testis","route":"/cancers/primary-testicular-lymphoma/"},{"id":"primary-mediastinal-b-cell-lymphoma","kind":"cancer","name":"Primary mediastinal (thymic) large B-cell lymphoma","route":"/cancers/primary-mediastinal-b-cell-lymphoma/"},{"id":"relapsed-refractory-hodgkin-lymphoma","kind":"cancer","name":"Relapsed and refractory classical Hodgkin lymphoma","route":"/cancers/relapsed-refractory-hodgkin-lymphoma/"},{"id":"retinoblastoma","kind":"cancer","name":"Retinoblastoma","route":"/cancers/retinoblastoma/"},{"id":"richter-transformation-cll","kind":"cancer","name":"Richter transformation of chronic lymphocytic leukaemia","route":"/cancers/richter-transformation-cll/"},{"id":"medulloblastoma-shh","kind":"cancer","name":"SHH-activated medulloblastoma","route":"/cancers/medulloblastoma-shh/"},{"id":"testicular","kind":"cancer","name":"Testicular germ cell tumours","route":"/cancers/testicular/"},{"id":"waldenstrom","kind":"cancer","name":"Waldenström macroglobulinaemia","route":"/cancers/waldenstrom/"}],"section":[{"id":"cell-therapy","kind":"section","name":"Cell Therapy","route":"/fronts/cell-therapy/"},{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"}],"technology":[{"id":"rejuv-tx-what-to-ask-for","kind":"technology","name":"After a transplant or cell therapy: what to ask for","route":"/technologies/rejuv-tx-what-to-ask-for/"},{"id":"apheresis-starting-material","kind":"technology","name":"Apheresis and starting-material collection","route":"/technologies/apheresis-starting-material/"},{"id":"rejuv-tx-prolonged-cytopenias","kind":"technology","name":"Blood counts that do not come back after CAR-T: ICAHT","route":"/technologies/rejuv-tx-prolonged-cytopenias/"},{"id":"cell-therapy-cold-chain","kind":"technology","name":"Cryopreservation and cell-therapy cold chain","route":"/technologies/cell-therapy-cold-chain/"},{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"},{"id":"g-csf-growth-factors","kind":"technology","name":"Growth factors: G-CSF and febrile neutropenia prevention","route":"/technologies/g-csf-growth-factors/"},{"id":"rejuv-tx-endocrine-and-cardiometabolic","kind":"technology","name":"Hormones, metabolism and the heart after transplant","route":"/technologies/rejuv-tx-endocrine-and-cardiometabolic/"},{"id":"rejuv-tx-infection-by-phase","kind":"technology","name":"Infection risk after transplant and cell therapy, phase by phase, and the prophylaxis that follows it","route":"/technologies/rejuv-tx-infection-by-phase/"},{"id":"rejuv-tx-iron-overload","kind":"technology","name":"Iron overload after transplant","route":"/technologies/rejuv-tx-iron-overload/"},{"id":"rejuv-tx-late-effects-overview","kind":"technology","name":"Late effects after a stem cell transplant","route":"/technologies/rejuv-tx-late-effects-overview/"},{"id":"rejuv-tx-immune-reconstitution-timeline","kind":"technology","name":"Rebuilding an immune system: the timeline, lineage by lineage","route":"/technologies/rejuv-tx-immune-reconstitution-timeline/"},{"id":"rejuv-frontier-immune-reconstitution","kind":"technology","name":"Rebuilding the immune system after treatment","route":"/technologies/rejuv-frontier-immune-reconstitution/"},{"id":"rejuv-tx-revaccination","kind":"technology","name":"Revaccination after transplant: the schedules, and where the UK and the US differ","route":"/technologies/rejuv-tx-revaccination/"},{"id":"rejuv-frontier-stem-cell-tourism","kind":"technology","name":"Stem cell clinics and stem cell tourism","route":"/technologies/rejuv-frontier-stem-cell-tourism/"},{"id":"tandem-transplant","kind":"technology","name":"Tandem autologous transplant","route":"/technologies/tandem-transplant/"},{"id":"rejuv-tx-long-term-follow-up-frameworks","kind":"technology","name":"Who is supposed to be watching: EBMT, CIBMTR, FACT-JACIE, and what a survivor is actually offered","route":"/technologies/rejuv-tx-long-term-follow-up-frameworks/"}],"drug":[{"id":"carmustine","kind":"drug","name":"Carmustine","route":"/drugs/carmustine/"},{"id":"defibrotide","kind":"drug","name":"Defibrotide","route":"/drugs/defibrotide/"},{"id":"etoposide","kind":"drug","name":"Etoposide","route":"/drugs/etoposide/"},{"id":"melphalan","kind":"drug","name":"Melphalan (including hepatic delivery system)","route":"/drugs/melphalan/"},{"id":"palifermin","kind":"drug","name":"Palifermin","route":"/drugs/palifermin/"},{"id":"plerixafor","kind":"drug","name":"Plerixafor","route":"/drugs/plerixafor/"},{"id":"thiotepa","kind":"drug","name":"Thiotepa","route":"/drugs/thiotepa/"}],"company":[{"id":"angiocrine-bioscience","kind":"company","name":"Angiocrine Bioscience","route":"/companies/angiocrine-bioscience/"}],"term":[{"id":"mrd","kind":"term","name":"Minimal / molecular residual disease (MRD)","route":"/terms/mrd/"},{"id":"lymphoma-tx-transplant-role","kind":"term","name":"Stem cell transplant in lymphoma: what it is still for","route":"/terms/lymphoma-tx-transplant-role/"},{"id":"lymphoma-decision-transplant-or-car-t","kind":"term","name":"Transplant or CAR-T at second line in diffuse large B-cell lymphoma","route":"/terms/lymphoma-decision-transplant-or-car-t/"}],"trial":[{"id":"acns0122","kind":"trial","name":"ACNS0122","route":"/trials/acns0122/"},{"id":"acns0333","kind":"trial","name":"ACNS0333","route":"/trials/acns0333/"},{"id":"aethera","kind":"trial","name":"AETHERA","route":"/trials/aethera/"},{"id":"anbl17p1","kind":"trial","name":"ANBL17P1","route":"/trials/anbl17p1/"},{"id":"bmt-ctn-0803","kind":"trial","name":"BMT CTN 0803","route":"/trials/bmt-ctn-0803/"},{"id":"cartitude-5","kind":"trial","name":"CARTITUDE-5","route":"/trials/cartitude-5/"},{"id":"anbl0532","kind":"trial","name":"COG ANBL0532","route":"/trials/anbl0532/"},{"id":"ielsg32","kind":"trial","name":"IELSG32","route":"/trials/ielsg32/"},{"id":"ielsg43","kind":"trial","name":"MATRix/IELSG43","route":"/trials/ielsg43/"},{"id":"perseus","kind":"trial","name":"PERSEUS","route":"/trials/perseus/"},{"id":"hr-nbl1","kind":"trial","name":"SIOPEN 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DiPersio","route":"/people/john-dipersio/"},{"id":"paul-richardson","kind":"person","name":"Paul G. Richardson","route":"/people/paul-richardson/"}],"target":[{"id":"cxcr4","kind":"target","name":"CXCR4","route":"/targets/cxcr4/"}],"paper":[{"id":"paper-perseus-dara-vrd-transplant-nejm-2024","kind":"paper","name":"PERSEUS: daratumumab added to bortezomib-lenalidomide-dexamethasone around autologous transplant in newly diagnosed myeloma","route":"/key-papers/paper-perseus-dara-vrd-transplant-nejm-2024/"},{"id":"paper-transform-liso-cel-lancet-2022","kind":"paper","name":"TRANSFORM: liso-cel CAR-T versus salvage chemotherapy and transplant in early-relapsing large B-cell lymphoma","route":"/key-papers/paper-transform-liso-cel-lancet-2022/"},{"id":"paper-zuma-7-axi-cel-second-line-nejm-2022","kind":"paper","name":"ZUMA-7: axi-cel CAR-T instead of salvage chemotherapy and transplant for large B-cell lymphoma that relapses early","route":"/key-papers/paper-zuma-7-axi-cel-second-line-nejm-2022/"}]}}