Autologous vs. Allogeneic Bone Marrow Transplants: A Comparative Analysis
Cancer and its treatments — for example, chemotherapy — can damage healthy stem cells. A stem cell transplantation (also known as a bone marrow transplant) may be required to replace these cells in the bone marrow. There are two classes of stem cell transplants used to treat leukaemia: allogeneic and autologous. In an allogeneic transplant, stem cells come from a donor. In an autologous transplant, the stem cells come from the person undergoing the surgery.
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What Are Stem Cells?
Each form of stem cell transplant needs a slightly different procedure, provides different benefits, and comes with different potential risks. If you or a loved one has leukaemia, it may be beneficial to understand how stem cell transplants work and how the two types differ.
Stem cells are a crucial part of the body because they can develop into any type of cell. Blood stem cells reside in bone marrow, where they divide and mature into different types of blood cells. These include:
- Red blood cells (RBCs) transport oxygen throughout the body
- White blood cells (WBCs), which help fight infections
- Platelets, which help with clotting
To keep you healthy, new cells help replace old, worn-out cells in the body. Transplanting stem cells can help prevent complications such as severe infection, haemorrhage, and anaemia that can occur when chemotherapy destroys healthy cells.
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Allogeneic Stem Cell Transplant
An allogeneic stem cell transplant is one treatment option for leukaemia. The term “allogeneic” refers to stem cells that come from a healthy donor who may or may not be a genetic match for the individual receiving them. The transplant can come from a family member or a stranger.
Benefits of Allogeneic Stem Cell Transplants
Because donor stem cells come from another person, they can help the recipient build a new immune system. Ideally, the stem cells will start producing new WBCs and immune cells that recognize and destroy any remaining leukaemia cells in the body. This is known as the graft-versus-tumour effect, and it can only occur with allogeneic stem cell transplantation.
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Procedure for an Allogeneic Stem Cell Transplant
During stem cell collection, a needle is inserted into an arm vein to collect the donor’s blood. The blood is then processed through a specialised device that removes the stem cells and returns the remaining blood to the donor. The stem cells are then frozen and can be used in a recipient many years later.
Before the stem cell transplant, the recipient is treated with high-dose chemotherapy and, in some cases, radiation therapy. This is referred to as a “conditioning treatment” since it prepares the body to accept the new stem cells. It is also referred to as a myeloablative treatment plan.
Chemotherapy and radiation kill any remaining leukaemia cells in the body and weaken the immune system to make the transplant successful. The treatment also clears the bone marrow so the new stem cells can grow and produce healthy blood cells.
After the conditioning period, the donor stem cells are delivered into the recipient via a catheter inserted into a blood vessel. The stem cells migrate through the body to the bone marrow, where they begin producing new blood cells.
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Complications With Allogeneic Stem Cell Transplants
Every cell in the human body has a special type of protein called a human leukocyte antigen (HLA) on its surface. Because a person’s immune system recognizes HLA proteins that are different from their own, this protein is critical in transplants. The immune system and the transplant may attack each other, resulting in graft-versus-host disease (GVHD), which can lead to transplant rejection.
There are a few options for preventing GVHD in allogeneic stem cell transplants: One option is for the donor to be the recipient’s identical twin, and the other is to administer medications to the recipient, such as chemotherapy or immunotherapy. These medications may include:
- Corticosteroids, such as prednisone or methylprednisolone
- Cyclosporine
- Prograf (tacrolimus)
- Rapamune (sirolimus)
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Autologous Stem Cell Transplant
An autologous stem cell transplant is another option for treating leukaemia. The word “auto” means “self,” and this treatment uses the recipient’s own stem cells for the transplant rather than a donor’s. Typically, autologous stem cell transplants are used to treat blood malignancies such as myeloma, Hodgkin lymphoma, and non-Hodgkin lymphoma.
Procedure for Autologous Stem Cell Transplant
In the first step of an autologous stem cell transplant, the recipient is treated with drugs that cause the body to produce more stem cells and move them into the bloodstream. This makes it easier to collect the stem cells using a needle inserted into a vein in the arm. The blood is then processed through a specialised device that removes the stem cells and returns the remaining blood to the recipient. The collected stem cells are then frozen for future use.
During the conditioning treatment (similar to the treatment in an allogeneic stem cell transplant), high-dose chemotherapy and radiation are used to kill any remaining leukaemia cells and prepare the bone marrow for the stem cells.
Once the conditioning phase is complete, the recipient’s stem cells are injected using a catheter placed into a blood vessel. The stem cells migrate through the body to the bone marrow and begin to produce new blood cells.
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Benefits and Drawbacks of Autologous Stem Cell Transplants
One benefit of an autologous stem cell transplant is that there is no risk of GVHD. Because the recipient is receiving their own stem cells, their immune system doesn’t recognize the cells as foreign.
Autologous stem cell transplants, unlike allogeneic transplants, don’t provide the benefit of a graft-versus-tumour effect because the recipient’s cells cannot generate a new immune system. Therefore, the person getting the autologous transplant is more likely to develop leukaemia again.
About Curebridge
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