How bones make blood - Melody Smith
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Cancer is a heterogeneous group of diseases that are characterized by abnormal cell growth that may impact various organs in the body. Cancer may occur in the solid organs or it may impact the blood cells. Cancers of the blood cells include leukemia, lymphoma and multiple myeloma. Patients these blood cancer are initially treated with agents, which are referred to as chemotherapy. Chemotherapy can arrest abnormal cell of the blood cells growth. However, patients with blood cancers whose disease does not respond to chemotherapy or whose disease returns despite chemotherapy more intensive treatment may be needed. One potential option is to consider a an allogeneic hematopoietic cell transplant, also known as a bone marrow transplant (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943393/), which may present the most likely option for a cure.
Oftentimes, the mention of the word “transplant” invokes the idea that the patient will need an operation. However, an allogeneic hematopoietic cell transplant is different from the transplant of a solid organ. An allogeneic hematopoietic cell transplant is similar to other transplants in that the recipient often needs a donor. If a patient does not have a donor within their family, then there are registries available to see if they have an unrelated donor. A donor is matched to the recipient by an immune classification called the human leukocyte antigen (HLA) complex. To learn more about the HLA complex, this link provides additional information: https://ghr.nlm.nih.gov/primer/genefamily/hla. Of note, the frequency and distribution HLA antigens varies by ethnic groups. This means that a patient in need of an allogeneic hematopoietic cell transplant is more likely to find a donor within a similar ethnicity to his or her own.
Sources of bone marrow for an allogeneic hematopoietic cell transplant include, peripheral blood and the bone marrow (https://bethematch.org/transplant-basics/how-transplants-work/). To learn more about alternative donor sources, such as cord blood (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5442719/) and haploidentical transplant (https://ascopubs.org/doi/10.1200/JGO.18.00130) please see the links provided.
The ultimate goal of an allogeneic hematopoietic cell transplant is to mediate graft versus tumor activity (https://ashpublications.org/hematology/article-lookup/doi/10.1182/asheducation-2017.1.693). Graft versus tumor activity refers to the anti-tumor activity that results when the donor’s T cells, which are a type of white blood cells, attack the cancer in the recipient. However, graft versus host disease may result if the donor’s T cells recognize differences in the HLA antigens between the donor and recipient (http://ar.iiarjournals.org/content/37/4/1547.long). This may cause significant morbidity and mortality when the donor T cell to attack the recipient’s organs, such as the GI tract, liver, or skin. Hence, when matching a patient with a donor great detail is given to the HLA compatibility.
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