The American journal of pediatric hematology/oncology · 1993
Choosing an alternative bone marrow donor among available family members.
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Henslee-Downey P J
Аннотация
PURPOSE: Bone marrow transplantation (BMT) can be curative for patients with hematological malignancies, marrow failure syndromes, and certain metabolic disorders. However, fewer than half of the patients who could benefit have a donor who is either an HLA-matched sibling or a phenotypically similar unrelated volunteer.
PATIENTS AND METHODS: The opportunity for allogeneic bone marrow transplantation is significantly increased by the use of partially mismatched, haploidentical related donors. The likelihood of finding a donor within the family is dependent on the acceptable degree of mismatch on the unshared chromosome. The degree of mismatch is expected to be approximately 10% for a one-antigen mismatch, 20-30% for a two-antigen mismatch, and > 95% for a three-antigen mismatch. Improvements in transplant techniques designed to enhance engraftment and to prevent the development of severe acute and chronic graft-versus-host disease have increased the feasibility of utilizing this readily available donor pool. Obviously, the ability to use a three-antigen mismatched related donor would make bone marrow transplantation available for almost every patient.
RESULTS: Recent studies combining in vitro and in vivo immunomodulation of donor lymphocytes have resulted in consistent engraftment and control of acute graft-versus-host disease.
CONCLUSIONS: These findings provide encouragement that there may need be no restriction on the availability of allogeneic marrow transplants as a therapeutic option for appropriate candidates.
PATIENTS AND METHODS: The opportunity for allogeneic bone marrow transplantation is significantly increased by the use of partially mismatched, haploidentical related donors. The likelihood of finding a donor within the family is dependent on the acceptable degree of mismatch on the unshared chromosome. The degree of mismatch is expected to be approximately 10% for a one-antigen mismatch, 20-30% for a two-antigen mismatch, and > 95% for a three-antigen mismatch. Improvements in transplant techniques designed to enhance engraftment and to prevent the development of severe acute and chronic graft-versus-host disease have increased the feasibility of utilizing this readily available donor pool. Obviously, the ability to use a three-antigen mismatched related donor would make bone marrow transplantation available for almost every patient.
RESULTS: Recent studies combining in vitro and in vivo immunomodulation of donor lymphocytes have resulted in consistent engraftment and control of acute graft-versus-host disease.
CONCLUSIONS: These findings provide encouragement that there may need be no restriction on the availability of allogeneic marrow transplants as a therapeutic option for appropriate candidates.