Bone marrow transplantation

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Bone marrow transplantation (usually more correctly haemopoietic stem cell transplantation, haemopoietic STC) is now a fairly established technique for last ditch rescue or cure with allogeneic stem cell transplantation in a number of haematological malignancies[1]. It may also work in viral infections confined to the immune system such as AIDS[2]. The two main types are:

  1. Allogeneic stem cell transplantation (also known as allograft)
  2. Autologous stem cell transplantation (own cells being re-transplanted)

Types

In rough order of immune mismatch. Note that immune mismatch may be harnessed to treat the underlying condition, e.g. graft-versus-leukaemia effect in acute myeloid leukaemia.

  • Autologous
  • Monozygous twin (syngeneic)
  • HLA-identical sibling
  • Matched unrelated donor (MUD), usually from as a volunteer unrelated donor (VUD)
  • Haplo-identical (50% match, e.g. sibiling/parent/child)
  • Umbilical cord/placental stem cell

Process

  • Matching (if allogeneic)
  • Harvest (from patient for autologous or donor for allogeneic)
  • Conditioning - typically involves myelo-ablative chemotherapy.
  • Transplant
  • Engraftment/recovery

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References

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