Quote:
Originally Posted by Lbrown
Hi Lisa,
Thanks for the explanation. Does that mean bone marrow failure diseases do not have clones?
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It depends on how broad your definition of bone marrow failure diseases is, Lbrown. "Aplastic anemia" and "myelodysplastic syndrome" are merely descriptions of symptoms rather than actual clones, so they are really catch-all categories for a set of disorders that meet certain criteria. Within that, however, you can have clonal disorders, like the chromosome mutations I mentioned earlier.
I'm pretty sure leukemia qualifies as a bone marrow failure disease, since AA and MDS are often considered "pre-leukemic" diseases. I have a friend with AML who was sheduled for a sibling marrow transplant, but because of some other complications they decided to try an autologous transplant instead. This is where they take your own marrow, remove the AML clone, and infuse it back into you. It still involves nuking your remaining marrow, which is risky in itself, but since you are getting your own cells back, you don't have the graft-vs-host problems that you would with an allogenic (donor) transplant, so it's somewhat easier on your system. He's doing great after 3 or 4 years. No sign of recurrence, although the impression I got is that relapses are more common if you get your own cells back. I could be wrong about that.
At any rate, you can't do that for AA because there is no clone to remove, although I've often wondered what would happen with my husband if they just tried to remove his trisomy 8 clone. Whether or not that would help him would depend on whether the mutation is what is causing his auto-immune attack, or whether it came on as a secondary result of it, and I think they don't really know that. The same may be true for other chromosomal anomalies in MDS. If they are not the whole picture it may not be worth trying to just remove the clone rather than doing a full-on transplant. I'm just thinking out loud here, I don't know if this is ever even considered as an option. I'm not sure if it would work for PNH either, but maybe someone will know.