By Hans Joachim Deeg M.D., Hans-Georg Klingemann M.D., Gordon L. Phillips M.D. (auth.)
In the past due Forties investigators saw that mice given supralethai doses of overall physique irradiation have been safe by means of infusion of conceivable spleen or marrow cells following irradiation, and that this was once entire by way of hemopoietic reconsti tution with donor cells as confirmed utilizing genetic markers. If the same procedure will be utilized to people, it may be attainable to regard leukemia sufferers with any dose of chemoradiotherapy so far as nonmarrow toxicity approved, after which rescue them via marrow transplantation. Early medical makes an attempt have been gen erally unsuccessful, ordinarily as a result of an absence of information of histocompatibility antigens and acceptable supportive care. those parts built really speedy throughout the Nineteen Sixties, and for nearly twenty years now scientific marrow transplan tation has been conducted with expanding good fortune. After at the beginning utilizing basically bone marrow from HLA indentical siblings, the sphere has increased swiftly to include HLA nonidentical similar donors, and lately even marrow from unrelated volunteer donors. additionally, for the reason that for varied sufferers who oth erwise may gain advantage from transplantation a donor can't be pointed out, there was a starting to be curiosity in utilizing the patient's personal (autologous) bone marrow. Our figuring out of the foundations of transplantation and our wisdom of the capability dangers and merits have speedy grown. every now and then it really is tough, despite the fact that, to come to a decision what's the best choice for a given patient.
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Extra resources for A Guide to Bone Marrow Transplantation
Unfortunately, it was difficult to obtain adequate HLA-typing ofthese pancytopenic patients, thus greatly hindering the identification of suitable allogeneic donors. ) Although the cost of autologous marrow harvest, cryopreservation and long-term storage would be substantial, the proven ability of cryopreserved autologous marrow to reconstitute hematopoiesis after marrow-Iethal ther~py without rejection or graft-vs-host disease makes it an attractive alternative to allogeneic marrow in this situation.
Therefore, such transplants may require improved methods of preventing or treating rejection or graft-vs-host disease to become c1inically feasible. In any case, while it is possible and quite likely that the overall results of even phenotypic-matched unre1ated marrow transplants will be somewhat inferior to genotypic-matched sibling transplants, the results will have to be roughly similar to justify the expense of these registries. Finally, using unre1ated donors opens the door to moral, legal and financial questions not posed with re1ated donors.
Other late complications should also be discussed, especially the possibility of second malignancy (currently a problem more theoretical than actual). Also, it is important to raise the issue of sterility; this complication is likely in patients receiving more intensive conditioning, and often is not considered by patients. 28 Pre-transplant Considerations Discussion with the Potential Donor It is likely that some potential donors do not exercise any real choice in the donation of marrow for transplantation, as it is usually assumed that they will participate.
A Guide to Bone Marrow Transplantation by Hans Joachim Deeg M.D., Hans-Georg Klingemann M.D., Gordon L. Phillips M.D. (auth.)