# Allogeneic stem cell transplantation

Source: https://onco.cc/technologies/allogeneic-hsct/  
OnCo record `allogeneic-hsct` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Allogeneic stem cell transplantation replaces a patient's blood system with a donor's after conditioning chemotherapy, so donor immune cells hunt down leukaemia left behind. It remains the only cure for adverse-risk acute myeloid leukaemia, high-risk acute lymphoblastic leukaemia and Richter transformation, at the price of graft-versus-host disease.

## Summary

Conditioning chemotherapy (myeloablative or reduced-intensity) followed by donor stem cells. The graft-versus-leukaemia effect provides ongoing immune surveillance; graft-versus-host disease is the price. Indicated in ELN adverse-risk AML in first remission, intermediate-risk with MRD positivity, relapsed disease, high-risk ALL, and Richter transformation. Post-transplant cyclophosphamide has made haploidentical donors routine; post-transplant maintenance (FLT3 inhibitors, azacitidine, menin inhibitors in trials) is reducing relapse.

## Fields

- Kind: Technology
- Status: standard-of-care
- Last checked: 2026-09-07
- Principle: Myeloablation eradicates host haematopoiesis; donor T cells recognise residual leukaemia via minor histocompatibility antigens.
- Since: 1957
- Strengths: Curative for otherwise incurable leukaemia; Graft-versus-leukaemia is an antigen-agnostic immune therapy
- Limitations: Treatment-related mortality 10-20%; Chronic GVHD; Relapse remains the main cause of failure

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Hematopoietic_stem_cell_transplantation
- Wikipedia: https://en.wikipedia.org/wiki/Hematopoietic_stem_cell_transplantation

## Connected records

- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Acute myeloid leukaemia](https://onco.cc/cancers/aml/), [Acute myeloid leukaemia in children](https://onco.cc/cancers/aml-paediatric/), [Acute myeloid leukaemia in older or unfit patients](https://onco.cc/cancers/aml-older-unfit/), [Acute promyelocytic leukaemia](https://onco.cc/cancers/apl/), [Adult T-cell leukaemia/lymphoma](https://onco.cc/cancers/adult-t-cell-leukaemia-lymphoma/), [Advanced systemic mastocytosis (aggressive SM, SM with an associated haematological neoplasm, mast cell leukaemia)](https://onco.cc/cancers/advanced-systemic-mastocytosis/), [ALK-positive anaplastic large cell lymphoma](https://onco.cc/cancers/alk-positive-anaplastic-large-cell-lymphoma/), [Blastic plasmacytoid dendritic cell neoplasm (BPDCN)](https://onco.cc/cancers/bpdcn/), [Burkitt lymphoma](https://onco.cc/cancers/burkitt-lymphoma/), [Chronic lymphocytic leukaemia](https://onco.cc/cancers/cll/), [Chronic myeloid leukaemia (CML)](https://onco.cc/cancers/cml/), [Chronic myeloid leukaemia, accelerated and blast phase](https://onco.cc/cancers/cml-advanced-phase/), [Chronic myeloid leukaemia, chronic phase](https://onco.cc/cancers/cml-chronic-phase/), [Chronic myelomonocytic leukaemia and MDS/MPN overlap neoplasms](https://onco.cc/cancers/cmml/), [Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome)](https://onco.cc/cancers/cutaneous-t-cell-lymphoma/), [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Extranodal NK/T-cell lymphoma](https://onco.cc/cancers/extranodal-nk-t-cell-lymphoma/), [FLT3-mutated acute myeloid leukaemia](https://onco.cc/cancers/aml-flt3/), [High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL)](https://onco.cc/cancers/all-paediatric-high-risk/), [Higher-risk myelodysplastic syndromes](https://onco.cc/cancers/mds-higher-risk/), [IDH1- and IDH2-mutated acute myeloid leukaemia](https://onco.cc/cancers/aml-idh/), [Infant acute lymphoblastic leukaemia (KMT2A-rearranged, under one year)](https://onco.cc/cancers/all-infant/), [Mantle cell lymphoma](https://onco.cc/cancers/mantle-cell-lymphoma/), [Multiple myeloma](https://onco.cc/cancers/multiple-myeloma/), [Multisystem Langerhans cell histiocytosis (with or without risk-organ involvement)](https://onco.cc/cancers/lch-multisystem/), [Mycosis fungoides](https://onco.cc/cancers/mycosis-fungoides/), [Myelodysplastic syndromes / neoplasms (MDS)](https://onco.cc/cancers/mds/), [Myeloproliferative neoplasms (PV, ET, myelofibrosis)](https://onco.cc/cancers/myeloproliferative-neoplasms/), [NPM1-mutated and KMT2A-rearranged acute myeloid leukaemia](https://onco.cc/cancers/aml-npm1-kmt2a/), [Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)](https://onco.cc/cancers/peripheral-t-cell-lymphoma/), [Philadelphia chromosome-like acute lymphoblastic leukaemia (Ph-like or BCR::ABL1-like ALL)](https://onco.cc/cancers/all-ph-like/), [Philadelphia chromosome-positive acute lymphoblastic leukaemia in children (Ph-positive ALL)](https://onco.cc/cancers/all-paediatric-ph-positive/), [Plasma cell leukaemia](https://onco.cc/cancers/plasma-cell-leukaemia/), [Post-transplant lymphoproliferative disorder (PTLD)](https://onco.cc/cancers/post-transplant-lymphoproliferative-disorder/), [Primary myelofibrosis](https://onco.cc/cancers/primary-myelofibrosis/), [Relapsed and refractory acute lymphoblastic leukaemia in children](https://onco.cc/cancers/all-paediatric-relapsed/), [Relapsed and refractory classical Hodgkin lymphoma](https://onco.cc/cancers/relapsed-refractory-hodgkin-lymphoma/), [Relapsed or refractory chronic lymphocytic leukaemia](https://onco.cc/cancers/cll-relapsed/), [Richter transformation of chronic lymphocytic leukaemia](https://onco.cc/cancers/richter-transformation-cll/), [Secondary and therapy-related acute myeloid leukaemia](https://onco.cc/cancers/aml-secondary/), [Sezary syndrome](https://onco.cc/cancers/sezary-syndrome/), [Systemic mastocytosis](https://onco.cc/cancers/systemic-mastocytosis/)
- fronts: [Cell Therapy](https://onco.cc/fronts/cell-therapy/)
- technologies: [After a transplant or cell therapy: what to ask for](https://onco.cc/technologies/rejuv-tx-what-to-ask-for/), [After ruxolitinib: belumosudil, axatilimab and ibrutinib in chronic GvHD](https://onco.cc/technologies/gvhd-belumosudil-axatilimab-ibrutinib/), [Bone, eyes, kidneys and lungs after transplant](https://onco.cc/technologies/rejuv-tx-bone-eyes-kidneys-lungs/), [Chronic graft-versus-host disease](https://onco.cc/technologies/gvhd-chronic-overview/), [Chronic GvHD organ by organ: skin, mouth, eyes, gut, liver, joints and genital tract](https://onco.cc/technologies/gvhd-organ-by-organ/), [Extracorporeal photopheresis for graft-versus-host disease](https://onco.cc/technologies/gvhd-photopheresis/), [Fertility, growth and what total body irradiation costs](https://onco.cc/technologies/rejuv-tx-fertility-and-growth/), [Hormones, metabolism and the heart after transplant](https://onco.cc/technologies/rejuv-tx-endocrine-and-cardiometabolic/), [Infection risk after transplant and cell therapy, phase by phase, and the prophylaxis that follows it](https://onco.cc/technologies/rejuv-tx-infection-by-phase/), [Iron overload after transplant](https://onco.cc/technologies/rejuv-tx-iron-overload/), [Late effects after a stem cell transplant](https://onco.cc/technologies/rejuv-tx-late-effects-overview/), [Mesenchymal stromal cells for tissue damage](https://onco.cc/technologies/rejuv-frontier-mesenchymal-stromal-cells/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/), [Preventing graft-versus-host disease, and what prevention costs](https://onco.cc/technologies/gvhd-prophylaxis/), [Quality of life after transplant and cell therapy](https://onco.cc/technologies/rejuv-tx-quality-of-life/), [Rebuilding an immune system: the timeline, lineage by lineage](https://onco.cc/technologies/rejuv-tx-immune-reconstitution-timeline/), [Rebuilding the immune system after treatment](https://onco.cc/technologies/rejuv-frontier-immune-reconstitution/), [Revaccination after transplant: the schedules, and where the UK and the US differ](https://onco.cc/technologies/rejuv-tx-revaccination/), [Second cancers after allogeneic transplant](https://onco.cc/technologies/rejuv-tx-second-cancers/), [Stem cell clinics and stem cell tourism](https://onco.cc/technologies/rejuv-frontier-stem-cell-tourism/), [Survival after transplant, and why the curve never quite rejoins the population](https://onco.cc/technologies/rejuv-tx-survival-after-transplant/), [The lungs after transplant: bronchiolitis obliterans syndrome](https://onco.cc/technologies/gvhd-lung-bronchiolitis-obliterans/), [Total body and total marrow irradiation](https://onco.cc/technologies/total-body-irradiation/), [Transfusion support and anaemia management](https://onco.cc/technologies/transfusion-support/), [When steroids fail: ruxolitinib for steroid-refractory GvHD](https://onco.cc/technologies/gvhd-ruxolitinib-steroid-refractory/), [Who is supposed to be watching: EBMT, CIBMTR, FACT-JACIE, and what a survivor is actually offered](https://onco.cc/technologies/rejuv-tx-long-term-follow-up-frameworks/)
- drugs: [Allogeneic regulatory T cell immunotherapy with HSPC and T cells-vldq](https://onco.cc/drugs/tregzi/), [Belumosudil](https://onco.cc/drugs/belumosudil/), [Busulfan](https://onco.cc/drugs/busulfan/), [Cyclophosphamide](https://onco.cc/drugs/cyclophosphamide/), [Defibrotide](https://onco.cc/drugs/defibrotide/), [Dorocubicel (UM171-expanded cord blood)](https://onco.cc/drugs/dorocubicel/), [Fludarabine](https://onco.cc/drugs/fludarabine/), [Omidubicel](https://onco.cc/drugs/omidubicel/), [Ruxolitinib](https://onco.cc/drugs/ruxolitinib/), [Thiotepa](https://onco.cc/drugs/thiotepa/), [Treosulfan](https://onco.cc/drugs/treosulfan/)
- companies: [Bellicum Pharmaceuticals](https://onco.cc/companies/bellicum/), [Neovii](https://onco.cc/companies/neovii/), [Vor Biopharma](https://onco.cc/companies/vor-biopharma/)
- terms: [ELN 2022 risk classification](https://onco.cc/terms/eln-risk/), [MRD-negative complete remission](https://onco.cc/terms/mrd-negative-cr/), [Richter transformation](https://onco.cc/terms/richter-transformation/), [Stem cell transplant in lymphoma: what it is still for](https://onco.cc/terms/lymphoma-tx-transplant-role/)
- journals: [Hematology/oncology and stem cell therapy](https://onco.cc/journals/hematology-oncology-and-stem-cell-therapy/)
- ideas: [MRD-guided transplant decisions in intermediate-risk AML](https://onco.cc/ideas/idea-mrd-guided-transplant-aml/), [Transplant-free Ph-positive ALL for MRD-negative adults](https://onco.cc/ideas/idea-transplant-free-ph-all/)
- pairings: [Caution: inotuzumab before transplant (veno-occlusive disease)](https://onco.cc/pairings/inotuzumab-then-transplant-caution/)
- people: [David L. Porter](https://onco.cc/people/david-porter/), [John F. DiPersio](https://onco.cc/people/john-dipersio/)
- roadmaps: [Paths to cures: interception, eradication, control](https://onco.cc/roadmaps/cure-paths/)
- targets: [CD52](https://onco.cc/targets/cd52/), [CD7](https://onco.cc/targets/cd7/)
- key papers: [ADMIRAL: gilteritinib pills versus chemotherapy for relapsed FLT3-mutated acute myeloid leukaemia](https://onco.cc/key-papers/paper-admiral-gilteritinib-flt3-nejm-2019/), [INO-VATE: inotuzumab ozogamicin, a CD22 antibody-drug conjugate, versus chemotherapy for relapsed adult B-cell ALL](https://onco.cc/key-papers/paper-ino-vate-inotuzumab-all-nejm-2016/), [QuANTUM-First: quizartinib added to intensive chemotherapy and continued as maintenance in newly diagnosed FLT3-ITD AML](https://onco.cc/key-papers/paper-quantum-first-quizartinib-lancet-2023/)
- trials: [BMT CTN 1102](https://onco.cc/trials/bmt-ctn-1102/), [EsPhALL (EsPhALL2004 and EsPhALL2010)](https://onco.cc/trials/esphall/), [MORPHO](https://onco.cc/trials/morpho/), [Study 2005-01](https://onco.cc/trials/study-2005-01/)
- institutions: [Fred & Pamela Buffett Cancer Center](https://onco.cc/institutions/nebraska-buffett/), [Indiana University Melvin and Bren Simon Comprehensive Cancer Center](https://onco.cc/institutions/iu-simon/), [Juravinski Cancer Centre / Escarpment Cancer Research Institute](https://onco.cc/institutions/juravinski/), [Masonic Cancer Center, University of Minnesota](https://onco.cc/institutions/minnesota-masonic/), [University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center](https://onco.cc/institutions/maryland-greenebaum/)

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