Wednesday, July 25, 2007

5/23/2007: "Finding a Cure" in M.U.D.?

My physicians at City of Hope (COH) have now determined that I am not a candidate for the autologous transplant (my own stem cells harvested and reinserted) due to the aggressivenature of my mantle cell lymphoma (MCL).

We are now turning to the allogeneic transplantmethod from an outside donor. The good news is that an initial search of the national database of donors turned up nealry 400 potential matchesfor my basic blood type and antigens. This meansthere is an ample pool from which to find a close match. This is most fortunate and promising for what could prove to be the eventual cure.

From my internet research, I found this about Allogeneic Stem Cell Transplant (allo SCT): READ MORE HERE

Defined as any transplant of stem cells between two individuals, whether they are related or unrelated. The sample the patient receives can come from the bone marrow through a surgical procedure or from the peripheral blood (peripheral blood stem cell transplant, PBSCT).

1) Either the bone marrow transplant or the PBSCT can be done in both auto and allogeneic transplants.

2) Typically allogeneic transplants have three phases:

A. Donor matching phase - cells from potential donors are tested for compatibility. MUD is a common abbreviation used. It means Matched UnrelatedDonor.

The donor experience? Potential donors are asked a series of questions to make sure they are healthy enough to donate and don’t pose an unacceptable risk of infection to the recipient. Risks for donors are minimal, and serious complications are rare. Problems such as sore throat or nausea may be caused by anesthesia.

B. Conditioning phase - use of high dose therapies to eradicate the disease. Myeloablative means that the treatment kills (ablates) the myeloid stem cells in the bone marrow - the cells that produce new blood cells.

Once ready to begin the transplant protocol,you are admitted to the hospital for high doses of chemotherapy and/or radiation therapy for what is called “conditioning.” This conditioning phase can take five to 10 days and is completed a day or two before the infusion of the stem cell product. The purpose of conditioning is to give high enough doses of chemotherapy and/or radiation to eliminate any cancerous cells that are present, to make room for the new cells, and to destroy your immune system. This is done to prevent rejection of the new donor cells.

C. Engraftment phase - the stem cells from a donor are given back to the patient to reconstitute the immune system. Sometimes purging techniques are used to clean the stem cells of residual tumor cells prior to engraftment, or shortly after.

Approximately two to four weeks after the transplant the patient can expect to see signs of the bone marrow “engrafting” or beginning to grow. The first sign of this is the production of white blood cells. Platelets often take a little longer to begin developing. Once "engrafted” and the patient condition is stable, discharge from the hospital is possible assuming the patient has no major side effects from the treatment.

Potential Advantages of Allo Transplants:

1. Tumor free graft
2. Undamaged stem cells
3. Avoidance of MDS/secondary AML
4. Graft versus lymphoma effect (the cure!) -- see note belowPotential Problems with Allo


1. Lack of suitable donors (not true in my case)
2. High treatment related mortality (see GVHD)
3. Regimen related toxicity
4. Infection
5. Time for treatment & recovery (6 months to one year)

Graft versus Host Disease (See GVHD for details)

Graft versus cancer effect With an allogeneic stem cell transplant, donor stem cells go from the patient's blood to his or her marrow. The new cells grow and provide a supply of red cells, white cells (including immune cells), and platelets. The donated stem cells make immune cells that are not totally "matched" with the patient's cells. (Patients and donors are matched to major tissue types but not minor tissue types.) For this reason, the donor immune cells may recognize the patient's cancer cells' minor tissue types as foreign and kill the cancer cells. This is called "graft versus cancer effect."

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