Table 3 General contraindications for HSCT in RMDs.
Criterion | Contraindications |
|---|---|
Active infections | Active infections and uncontrolled chronic infections are absolute contraindications. Careful consideration should be given for controlled chronic infections. |
Malignancy | Active solid neoplasia and haematological malignancies, or cancer diagnosed within the last 5 years, except for cervical ’in situ’ neoplasia (CIN) and non-melanoma skin cancer. For patients in remission for <5 years, HSCT should be discussed individually with the referring oncologist. |
Cardiac function | Congestive heart disease with LVEF ≤40% as measured by TTE, uncontrolled arrhythmias, severe non controlled ischemic cardiac disease, pericardial effusion with hemodynamic alterations. For SSc patients, specific contraindications should be considered (see section below). |
Lung function | DLCO-SB ≤40%. In some exceptional cases, lower DLCO may be accepted. |
Liver and kidney function | Caution is required in patients with increased liver enzymes above 3 ULN and GFR of ≤30 ml/min but alterations in the value should be discussed individually in MDT. |
Cytopenia | Defined as: Neutropenia <0.5 × 109/L and/or thrombocytopenia <50 × 109/L and/or CD4+ lymphopenia <200 × 109/L. Patients with immune cytopenia associated with the RMD should be considered on an individual basis following bone marrow examination and other relevant investigations to exclude bone marrow disease (i.e. myelodysplastic syndrome, aplastic anaemia). Individual considerations by MDT are recommended. Ethnicity is also a consideration, and neutropenia related to ethnicity is not a contraindication, although full work up including Duffy typing is recommended [88]. |
Bleeding disorder | Uncontrolled bleeding disorder |
Psychiatric disease | Uncontrolled psychiatric disease |
Pregnancy | Pregnancy and lack of appropriate contraception during the procedure |
Smoking | Active smokers |
