Page 62 - Eshre 2018
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Gaps in knowledge 2
Indications for HSCT are changing
Allo HSCT
Auto HSCT
Non-malignat conditions will dominate in future
Increase of allogeneic HSCT
• Hemoglobinopathy
• Primary immunodeficiences
• Bone marrow failure
Only smaller increase in autologous HSCT
• Solid tumors (high risk neuroblastoma and brain tumors)
• Non-Hodgkin's lymphoma
Adapted from Hussein et al. Bone Marrow Transplantation 2017; 52:120–125
Hematological malignancy is no more the major indicatiowwnw.hfeolsirnkpi.fi/eyliodpisatotric HS2C6.5T.2018 21
Gaps in knowledge 3
There may be genetic susceptibility to treatment related subfertility
>10% of pediatric cancer patients will have germ line mutation in cancer predisposition gene, RASopathy or telomeropathy
Germ line mutations are frequent in primary immunodeficiency and bone marrow failure
• Increased risk to treatment related toxicity
• Increased risk to subsequent cancer
• Increased risk to subfertility?
Adapted from Zhang NEJM 2015;373:2336-46
WGS (whole genome sequencing) broadens our knowlege about genetic variation
www.helsinki.fi/yliopisto 26.5.2018 22
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