Transplants have played a vital role in cancer treatment in the past few years. Many leukemia and lymphoma patients have benefited from this procedure. Many lab tests have to be performed before becoming a candidate to receive a transplant. There are three types of transplants that are available in the medical community.
Autologous
Autologous HSCT requires the extraction (
apheresis)
of haematopoietic stem cells (HSC) from the patient and storage of the
harvested cells in a freezer. The patient is then treated with high-dose
chemotherapy with or without
radiotherapy with the intention of eradicating the patient's malignant cell population at the cost of partial or complete
bone marrow
ablation (destruction of patient's bone marrow function to grow new
blood cells). The patient's own stored stem cells are then returned to
his/her body, where they replace destroyed tissue and resume the
patient's normal blood cell production. Autologous transplants have the
advantage of lower risk of infection during the immune-compromised
portion of the treatment since the recovery of immune function is rapid.
Also, the incidence of patients experiencing rejection (
graft-versus-host disease)
is very rare due to the donor and recipient being the same individual.
These advantages have established autologous HSCT as one of the standard
second-line treatments for such diseases as
lymphoma.
However, for others such as
Acute Myeloid Leukemia,
the reduced mortality of the autogenous relative to allogeneic HSCT may
be outweighed by an increased likelihood of cancer relapse and related
mortality, and therefore the allogeneic treatment may be preferred for
those conditions.
Researchers have conducted small studies using non-myeloablative
hematopoietic stem cell transplantation as a possible treatment for type
I (insulin dependent) diabetes in children and adults. Results have
been promising; however, as of 2009 it was premature to speculate whether these experiments will lead to effective treatments for diabetes.
Allogeneic
Allogeneic HSCT involves two people: the (healthy) donor and the (patient) recipient. Allogeneic HSC donors must have a tissue (
HLA) type that matches the recipient. Matching is performed on the basis of variability at three or more
loci
of the HLA gene, and a perfect match at these loci is preferred. Even
if there is a good match at these critical alleles, the recipient will
require
immunosuppressive medications to mitigate
graft-versus-host disease. Allogeneic transplant donors may be
related (usually a closely HLA matched sibling),
syngeneic (a
monozygotic
or 'identical' twin of the patient - necessarily extremely rare since
few patients have an identical twin, but offering a source of perfectly
HLA matched stem cells) or
unrelated (donor who is not related
and found to have very close degree of HLA matching). Unrelated donors
may be found through a registry of bone marrow donors such as the
National Marrow Donor Program.
People who would like to be tested for a specific family member or
friend without joining any of the bone marrow registry data banks may
contact a private HLA testing laboratory and be tested with a mouth swab
to see if they are a potential match. A "
savior sibling" may be intentionally selected by
preimplantation genetic diagnosis
in order to match a child both regarding HLA type and being free of any
obvious inheritable disorder. Allogeneic transplants are also performed
using umbilical
cord blood
as the source of stem cells. In general, by transplanting healthy stem
cells to the recipient's immune system, allogeneic HSCTs appear to
improve chances for cure or long-term remission once the immediate
transplant-related complications are resolved.
A compatible donor is found by doing additional HLA-testing from the
blood of potential donors. The HLA genes fall in two categories (Type I
and Type II). In general, mismatches of the Type-I genes (i.e. HLA-A,
HLA-B, or HLA-C) increase the risk of graft rejection. A mismatch of an
HLA Type II gene (i.e. HLA-DR, or
HLA-DQB1) increases the risk of graft-versus-host disease. In addition a genetic mismatch as small as a single
DNA base pair
is significant so perfect matches require knowledge of the exact DNA
sequence of these genes for both donor and recipient. Leading transplant
centers currently perform testing for all five of these HLA genes
before declaring that a donor and recipient are HLA-identical.
Race and
ethnicity
are known to play a major role in donor recruitment drives, as members
of the same ethnic group are more likely to have matching genes,
including the genes for HLA.
Synogeneic
Syngeneic bone marrow transplantation is a procedure in which a person receives
bone marrow donated by his or her healthy
identical twin. This is more of a specific term for a for the procedure above.
For more information:
http://www.cancer.gov/cancertopics/factsheet/Therapy/bone-marrow-transplant
http://en.wikipedia.org/wiki/Syngeneic_bone_marrow_transplantation