Autologous hematopoietic stem cell transplantation (auto-HSCT, ASCT) is a treatment in which the patient's own stem cells are collected, high-dose (myeloablative) chemotherapy is administered, and these stem cells are then reinfused to restore bone marrow function. The aim is to maximize the antitumor effect of high-dose chemotherapy while preventing permanent marrow failure. More than 40,000 autologous transplants are performed worldwide each year. Unlike allogeneic HSCT, there is no risk of GVHD because the patient's own cells are used; tolerance is therefore better and treatment-related mortality (TRM) is much lower (1-3%).
Main indications include: (1) Multiple myeloma — standard consolidation after induction in younger fit patients; (2) Hodgkin lymphoma — consolidation after salvage chemotherapy in refractory or first-relapse disease; (3) Diffuse large B-cell lymphoma (DLBCL) — consolidation after salvage chemotherapy (DHAP, ICE, GDP) in first relapse or primary refractory disease, although CAR-T cell therapy has partially shifted this indication in recent years; (4) Mantle cell lymphoma — first-line consolidation in young fit patients after the Nordic regimen; (5) Follicular lymphoma — selected relapse cases; (6) Refractory germ cell tumors — with high-dose chemotherapy regimens; (7) Autoimmune diseases — refractory multiple sclerosis, severe systemic sclerosis, aplastic anemia (special situations).
The transplant process involves: (1) Mobilization with G-CSF (filgrastim, pegfilgrastim) with or without chemotherapy (cyclophosphamide) to move stem cells from the marrow to peripheral blood; plerixafor is used in patients refractory to mobilization; (2) Leukapheresis — collection of CD34+ stem cells from peripheral blood, targeting at least 2 × 10⁶ CD34+/kg (4-6 × 10⁶/kg in myeloma to allow for tandem transplant); (3) Cryopreservation of the collected cells; (4) Conditioning regimen tailored to the disease — high-dose melphalan in myeloma, BEAM (carmustine + etoposide + cytarabine + melphalan) or similar in lymphomas; (5) Stem cell infusion (day 0); (6) Supportive care until engraftment (10-14 days) — transfusions, antibiotic, antifungal, and antiviral prophylaxis, mucositis management, and G-CSF; (7) Engraftment with neutrophil and platelet recovery, allowing hospital discharge; (8) Long-term follow-up for progression-free survival and late complications (secondary MDS/AML, infection, endocrine). Tandem (double) autologous transplantation may benefit high-risk myeloma patients. Maintenance therapy after autologous transplant (lenalidomide in myeloma, brentuximab vedotin in Hodgkin lymphoma) extends progression-free survival.