Stem cell transplant vs. bone marrow transplant?
 

What is the deciding factor(s) on which type of transplant is performed? Or, is there any choice?

Bailie,

I could not find the article, but Peripheral Blood Stem Cell Transplant (PBSCT) is used somewhere between 70% and 80% of the time from what I have read, and I believe that this is done primarily for the comfort of the donor. The results of transplant seem to have some positives and negatives for each method. This would definitely be something to discuss with your doctor as it is a good and interesting question.

From what I understand some cord blood transplants are used: 1) When there isn't a live adult 10/10 HLA compatible donor, or 2) when a previous BMT using bone marrow aspiration from a donor has failed. Cord blood from what I understand is a little more forgiving in HLA type. They measure 6 things and give you a 6/6 match rather than a 10/10 match but I don't know what the 6 things in the HLA are that need to match. The problem with cord blood is that in a single cord there usually isn't enough blood in the cord for good engraftment in an adult, they generally use them for children under the age of 10. I have read about adults getting a double cord blood transplant from two unrelated cords if their first BMT fails (i.e., fails to engraft.) There's also a theory that getting cord blood lessons your chance of getting GVHD, but that is still under test in clinical trials and hasn't been proven.

A friend of mine was called to potentially donate bone marrow recently, and he would be doing PBSCT because he's had previous surgeries on his back, so no doctor wants to aspire anything from his spine. But the NIH articles by Neil Young that I've read says that PBSCT is less effective in transplants than bone marrow aspiration for AA patients.

My doctor at MSK happens to be a cord blood specialist... As co-incidence I met one of her patients at hope lodge, who only had a 5/10 halpo sister match...

The doctor gave him two cord blood transplants 9/10 and 8/10 and his sisters' 5/10 stem cells, his sisters' cells were supposed to add GVL effect until the two cord blood grafts could take hold...

Only talked with him once, but I thought it interetesting the things that they are trying now adays.... His wife was home with a three month old and a three year old...

From what I read the marrow contains the stem cells so you extract the stem cells from the marrow as opposed to collecting them peripherally the studies indicate that PSCT are just fine. In the end your collecting the same stem cells so I don't understand the difference. I do know that the donor would feel uneasy about having someone pull marrow from their hip as opposed to a shot of Neutrogen followed by a blood donation. In the end its confusing and I accept that they do what they do "because".. :)

From the research findings I've read, it appears that SCT confers a slightly lower chance of relapse but a slighly higher chance for long term chronic GVHD than BMT. Thus, the overall survival rates tend to balance out. Each transplant center has its own protocols and emphasis, and it is they who determine source of cells used. Johns Hokpins places a great deal of emphasis on preventing or lessening GVHD, the probable reason they use bone marrow.

Something interesting I learned from my matched unrelated donor after she attended a conference with other donors. She said they compared notes on the procedures they'd gone through and the aftereffects. A lot of the SCT donors had unpleasant flu like reactions to the drug used to increase/mobilize the stem cells in the bloodstream. My donor said she was sore and a little tired for about a month after her marrow donation. After talking with the others, she said she was glad she donated marrow and given the choice, she would do the same again. However, she also said none of the donors had regrets and would all donate again. Every one of them is a hero!