What Are the Criteria for Becoming a Bone Marrow Transplant Donor?

Allogeneic bone marrow transplantation is pretreated by high-dose radiotherapy and chemotherapy or other immunosuppressants to remove tumor cells and abnormal cloned cells in the recipient, block the pathogenesis, and then transplant the allogeneic hematopoietic stem cells to the recipient, so that the recipient can rebuild normal hematopoietic Immunization, and a therapeutic means to achieve therapeutic goals.

Allogeneic bone marrow transplantation

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Allogeneic bone marrow transplantation is pretreated by high-dose radiotherapy and chemotherapy or other immunosuppressants to remove tumor cells and abnormal cloned cells in the recipient, block the pathogenesis, and then transplant the allogeneic hematopoietic stem cells to the recipient, so that the recipient can rebuild normal hematopoietic Immunization, and a therapeutic means to achieve therapeutic goals.

Chinese name

Allogeneic bone marrow transplantation

Foreign name

Allogeneic bone marrow transplantation

Chinese name: Allogeneic bone marrow transplantation

Including allogeneic transplantation (sibling, non-blood, haplotype); allogeneic transplantation (twin); xenotransplantation.

1.Same species

Allogeneic bone marrow transplantation is a fairly advanced treatment method, which is mainly used to treat malignant hematological diseases, non-malignant refractory blood diseases, genetic diseases and certain solid tumors, and has achieved good results. For example:

1. First, there must be a suitable bone marrow provider, and it is best to have an all-consistent gene provider. 2. A complete response to chemotherapy must be required. 3, generally under 45 years of age. 4, no serious liver, kidney, heart, lung, brain and other important organ damage; no severe diabetes, hepatitis, hypertension, cerebral infarction, heart disease; no severe mental disorders.

Stem cells can be collected from the bone marrow or peripheral blood of the donor.

1. Bone marrow transplantation (BMT) collection: Bone marrow is taken from the donor's sacrum with fine needles. These stem cell-rich bone marrow will be stored for transplantation. During the collection, the donor is under anesthesia and will not feel pain. At present, this method is basically not used.

(1) Select HLA (Human Leukocyte Antigen) donors that are completely matched. The order of selection is sibling HLA genotype matching, followed by HLA phenotypic family members, and then a family member or HLA table with incompatible HLA loci. Type unrelated donors, and finally, choose an unrelated donor or family member with two or three HLA sites that do not match.

(2) The preparation of the recipient should verify and determine the diagnosis and classification of leukemia. The general age should be limited to 45-50 years old. The functions of important organs are basically normal. Various infections in the body should be cleared, and a comprehensive experience and Necessary tests and auxiliary examinations are generally more than a dozen items. The recipient was admitted to a sterile laminar flow ward a week in advance.

(3) Histocompatibility antigen and gene matching.

(4) BMT pretreatment should reach three months. The first is to destroy the original hematopoietic cells in the recipient's body and prepare the space for implantation of hematopoietic stem cells. The second is to suppress the immune cells and functions in the recipient's body, which is conducive to the transplantation of bone marrow. The third is to clear and kill leukemia cells in the recipient.

(5) Bone marrow collection, processing, and infusion: The donor bone marrow is collected under sterile conditions in the operating room on the day of bone marrow infusion, and filtered to be transfused to the recipient as soon as possible after filtering to avoid loss of hematopoietic stem cells. The bone marrow of patients with ABO incompatibility must be processed before infusion.

(6) Nutrition and supportive treatments that are often necessary during BMT.

(7) Early prevention and treatment of BMT complications, elimination of gastrointestinal toxicity, control of multiple infections, bleeding and other major complications.

(8) Prevention and treatment of advanced complications of BMT, such as chronic graft-versus-host disease.

Bone marrow transplantation generally goes through five barriers: 1. Chemotherapy before transplantation. 2. Transplantation. 3. Immunity rejection after transplantation. 4. Infection. 5. Chemotherapy after transplantation. The success rate of bone marrow transplantation is tested by many factors and time:

Only by successfully passing the above five levels in turn, and after a genetic test is performed half a year later, the gene expression of the marrow donor is found in the patient, and the examination of the bone marrow, blood, and important organs are normal, without obvious symptoms, can it be considered truly successful.

This is related to the type of patient's condition, BMT timing, organ function, autoimmune response, complications of the transplantation process and the matching rate of the donor site and the patient's gene locus, and the comprehensive level of the transplant hospital. The true success rate of transplantation is reported by the news media at about 50%, but recognized by the medical community at about 33%. That is, 1/3, 1/3, 1/3 Views: 1/3 of patients fail in transplantation; 1/3 in transplantation Relapse within the second half of the year; 1/3 of the patients received a successful transplant.

Acute blood leukemia

The superiority of bone marrow transplantation over ordinary chemotherapy is fully reflected in acute leukemia. This therapy can significantly improve the disease-free survival rate of patients with acute leukemia. According to a large case analysis of the Fred Hutchinson Cancer Research Center and IBMTR, the 3-year disease-free survival rate of AML after receiving ALLo-BMT for the first time can reach about 50%; while the 3-year disease-free survival rate of chemotherapy patients in the same period is only 18 -27%.

Chronic myelogenous leukemia

Allogeneic bone marrow transplantation (BMT) is currently the only method that can cure chronic myelogenous leukemia. CML patients who are in the chronic stage can receive 60-90% disease-free survival after 5-year transplantation. The domestic statistical results are as follows: CML patients in the chronic phase receive sibling allogeneic bone marrow transplantation with the same HLA matching, and the long-term disease-free survival rate is 80%. CML patients entering the accelerated phase or sudden change phase are less effective than those in the chronic phase.

Malignant lymphoma

First consider an autologous bone marrow transplant.

Multiple myeloma

In the past, MM patients were considered unsuitable for BMT. With the advancement of supportive care and the emergence of young patients, the number of successful cases of MM in BMT has gradually increased. 150 patients with MM received bone marrow transplantation. The 3-year disease-free survival rate of patients receiving BMT in the first remission period was 69%.

Myelodysplastic syndrome

(MDS) BMT treatment of MDS can make the 3-year disease-free survival rate of patients close to 50%, and a considerable part can be cured, especially for young patients who receive BMT early can get better results.

Severe aplastic anemia

(SAA) is the disease that receives the most BMT among non-tumorous diseases. If the patient has not transfused BMT, the long-term survival rate can reach 80%.

other

Hereditary immunodeficiency disease, globin production anemia, etc.