ABSTRACT

With the advent of peripheral blood stem cells for haematopoietic rescue, autograftrelated mortality has dropped to less than 5-10% in most patient groups. At the other extreme, procedure-related mortality is still in excess of 50% in high-risk patients undergoing allografts from mismatched and unrelated donors [1,2]. Although only one death has been reported so far in a healthy donor as a consequence of donating marrow [3], it is a procedure associated with significant morbidity, including the risk of anaesthesia, blood loss and trauma to skin, blood vessels, nerves, muscle and bone [4,5] and is of no intrinsic benefit to the donor. Also, blood and marrow transplants are among the most expensive medical procedures, the ultimate burden of which falls upon society. A decision to embark upon a transplant procedure is therefore not a casual one. It is important to determine the appropriateness of the proposed procedure in a given individual and in the disease and stage being treated.