Resource Guide for Bone Marrow/Stem Cell Transplant
Like other medical science fields, as more is learned about various diseases, new strategies are considered. Bone marrow/stem cell transplant holds great promise. Clinical trials are testing new approaches, new drugs, and new protocols. The number of people who benefit from transplant continues to grow. Some remarkable techniques and newer trends in bone marrow/stem cell transplant include:
One newer option is the mini-transplant. It is called a "mini"-transplant because lower doses of chemotherapy and radiation are used. With a mini-transplant, the donor's cells and patient's cells "co-exist" in the body for a while and work together to fight cancer cells. Mini-transplants require a matched donor. This procedure may be a promising option for older patients or those who might not be able to tolerate full dose treatment. People with an inherited immune blood disorder or an immunodeficiency may also benefit from this treatment. Strategies are being evaluated and researchers are "cautiously optimistic" about the mini-transplant option. Because data is not yet complete, it is too early to offer success rates.
Umbilical Cord Blood Transplants
There are far-reaching applications for the use of umbilical cord blood stem cells for transplant. The advantages are many. Cord blood, for example, is rich in stem cells. It can be frozen, stored and readily available. Cord blood poses a lower risk of graft versus host disease (GVHD) and when it does occur, seems to be milder. While most umbilical cord blood transplants have been with patients weighing less than 90 pounds (children), research continues on its adult application. Children require fewer stem cells during transplant and cord blood may offer a sufficient supply. Adults routinely require more stem cells for transplant.
The wider availability of cord blood may be particularly valuable in meeting the desperate need for stem cell donors in minority groups. Efforts are underway to encourage cord blood donations. Various communities have set up repositories where donated cord blood is stored, increasing the chances of locating matches among groups that are under-represented in the bone marrow registries. Interested expectant parents have the opportunity to donate umbilical cord blood to an unrelated registry. Otherwise medical opinion is that unless you have an existing reason to save it for a family member, it is not advisable.
These are specifically timed autologous transplants designed to provide maximum tumor kill. Enough stem cells are collected (prior to first transplant) to rescue the patient after two sessions of high dose chemotherapy/radiation.
A second transplant may be recommended if a disease returns following transplant or if the donor's cells do not engraft. The type of treatment and source of cells will depend on the circumstances. This generally poses increased risk as the patient has already had extremely high doses of chemotherapy/radiation or a prolonged period of being immune compromised.
This is the process where certain kinds of white blood cells called T-lymphocytes (the cells responsible for GVHD) are removed from the donor's stem cells in an attempt to decrease the incidence of graft versus host disease and increase survival.
Donor Lymphocyte Infusion (DLI)
This presents a new strategy for managing relapse after BMT for patients with hematological malignancies such as CML, AML or ALL. The patient does not require chemotherapy or radiation prior to this therapy. DLI is associated with significant risk due to graft versus host disease and low white blood cell count that increases the patient's susceptibility for infection and bleeding. In the future, DNA technology (gene testing) will lead to a better understanding of what triggers malignancies in the body's cells and high doses of chemotherapy may be replaced with new treatment options.
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