Donor Cells Versus Own Cells For Transplant
Dear OncoLink "Ask The Experts,"
I have a friend with leukemia, and he started his second round of chemotherapy, hoping to get the remaining cancer cells. Then, after this secon0d round his doctor says he will take tests and undergo biopsy again to see if he is in remission. Our friend is going to use his own bone marrow cells rather than a donor. My question is, wouldn't a donor be better so the leukemia won't come back, rather than him using his own cells in case the chemo didn't kill some of the leukemia cells?
Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:
There are pluses and minuses to both an allogeneic (donor cells) transplant and an autologous (your own cells) transplant, but not all patients have both options. In order to receive a donor's cells, you must find someone whose HLA typing is the same or very similar sometimes referred to as a match. The best donors are siblings (sisters or brothers), as they got their cellular, genetic makeup from the same parents. If siblings do not match, or a person does not have siblings, doctors will test other members of the family. If no one in the family matches (about 70% of patients do not have a family match), doctors turn to the National Marrow Donor Program (NMDP), a national organization that coordinates bone marrow donation. The NMDP registry contains 5.5 million potential donors and 40,000 units of umbilical cord blood, which can also be used. Despite these large numbers, many patients will not find a match in the NMDP registry. Those patients would then have to use their own cells. The allogeneic transplant also requires the patient to meet certain health criteria, as it has more toxicity than an autologous transplant. If a patient is too ill, autologous transplant may be their only option.
One important benefit to allogeneic transplant is that the donor's cells have a different immune system with the ability to attack any remaining cancer cells in the patient. This is called the graft versus leukemia effect. On the other hand, the donor's cells may actually attack normal cells in the patient's body because it sees these cells as foreign. This is called graft versus host disease, is undesirable, and can be very severe.
You can read more about both types of transplants in the following articles: