Transplant question

[melleejohn]

Hi all...my husband has Mantle Cell Lymphoma and we are in the beginning stages of getting him ready for a stem cell transplant. My questions are: I read somewhere that a female donor is better for a male recipient. Has anyone heard of this before? Also, our two children (adult kids) are a 50/50 match....do you think we could/should look elsewhere for a better match? There are no other family members as his parents have both passed away and his siblings are half siblings that we have no contact with. Just looking for info to get started on all of this. Thanks so much!!

[rar]

In general a male is better for a male SCT because the male had never become pregnant and hasn't had to fight off fetuses. I received a 10/10 match from my 66 year old baby sister over a year ago. In the year since SCT, aside for some speed bumps I have been doing pretty well. My other choices were a sister no rug rats who had been cured of cancer and another sister who had 3 children. I also have 3 brothers who all matched each other but not me. The doctor picked my baby sister without hesitation. You may also consider cord blood or MUD, but in the end trust your doctors.

I am 100% engrafted. As I understand I can go commit a crime and leave some blood there and the police will be looking for a female.

Ray

[melleejohn]

Thanks Rar! So, if the kids are a 50/50 match that means 5/10 match? Our oncologist thinks that is OK. I am concerned when I am reading about 8/10 matches....and higher. I guess I would need to "push" to have them search a bit for a better match? Your thoughts? I really am concerned about a rejection. (And I like your comment about leaving blood...funny!)

[rar]

In general you will be either a 0/10, 5/10 or 10/10 match with with your siblings and probabilities are 25%, 50% or 25%.

If you google haploid SCT you get a lot of hits for example:
http://www.ncbi.nlm.nih.gov/pubmed/16965686
Haploid HLA-matched allo-HSCT is a relatively efficient method for the treatment of patients with malignant hematological disease, who have no related matched donors. Nevertheless, strict administration should be carried out since it's a high risk approach.

Personally I think I would prefer an good unrelated 10/10 but listen to your doctors.

Keep in mind that either rejection or GVHD can kill you. I am having some GVHD and the doctor said with too much immuno we kill you with rejection and too little we kill you with GVHD. It is a fine line in between and we really don't know where that line is. No regrets on the SCT.

Ray

[melleejohn]

Thanks so much. I thought that a higher match would equal a better outcome. We are doing this at Johns Hopkins. As we get further into this I will be asking a bunch of questions. Again, I assumed we could find (hopefully) a better match and not go directly with the kid's donation.

[DanL]

Melleejohn,

I have to go with the 10/10 match if it is available. Johns Hopkins has been a pioneer with the 5/10 haploid approach and has been successful. They use a alot more immune suppression to help with the rejection concerns. In general, the less the match, the higher the risk of gvhd and its related side effects.

As Ray says, go with what the doctors recommend. I had a 10/10 MUD in February of 2014. GVHD has been lower grade and manageable from day one.

Dan

[evansmom]

I'll third that notion...If it were myself or my son (who had a successful 9/10 MUD BMT), I'd definitely push for an 8/10, 9/10 or 10/10 unrelated donor. Depending on where the mismatches are, a slightly imperfect match can be very successful. It's a very fine line indeed between successful transplant, graft failure and graft versus host. I'm not sure however if a bit of GVH is desired the same way it is in treating leukemia with a graft versus leukemia effect. That would be a good question to ask the team.

At any rate, your husband will be in very good hands at JH, but please realize that there certainly is considerably more risk of serious complications with one of the kids being the donor (haploid transplant).

Best wishes.