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Allogeneic stem cell transplant (allo-SCT)

aka allo-SCT, alloSCT, allo-HSCT, alloHCT, HSCT, HCT, allogeneic transplant, allogeneic transplantation, allogeneic stem cell transplantation, allogeneic HSCT, allogeneic, donor transplant, bone marrow transplant, BMT, haploidentical, haplo, matched sibling donor, matched unrelated donor, MUD, cord blood transplant, post-transplant cyclophosphamide, PTCy, donor lymphocyte infusion, DLI, transplant-eligible, transplant-ineligible

Replacing a patient's blood system with a donor's: chemotherapy wipes out the marrow, donor stem cells rebuild it, and the donor's immune cells hunt down leftover leukaemia. The only cure for many high-risk blood cancers, and the riskiest treatment in oncology.

Used for adverse-risk or relapsed AML, high-risk ALL and MDS, myelofibrosis and some lymphomas. Donors are HLA-matched siblings, matched unrelated donors from registries, haploidentical relatives (now safe with post-transplant cyclophosphamide) or cord blood. Conditioning is myeloablative or reduced-intensity depending on age and fitness. The graft-versus-leukaemia effect is the cure mechanism; graft-versus-host disease, infection and organ toxicity are the price, with treatment-related mortality of 10-25%. MRD-guided transplant decisions, CAR-T bridging and maintenance drugs after transplant (FLT3 inhibitors, azacitidine) are refining who needs it.

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