Info

Comparison of autologous and allogeneic SCT

Autologous

Allogeneic

Wide age range, generally <65

Age range generally <55

No need for donor search if BM clear

Sibs have ~1 in 4 chance of match

Not feasible if BM involved

May be used in patients with BM disease

Risk of tumour cell re-infusion

No tumour contamination of graft

Not all patients can be mobilised

Donor search may impose delay

No GvHD

GvHD mortality and morbidity

No immunosuppression

Graft-versus-leukaemia (GvL) effect

Low early treatment related mortality

(2-5%)

Higher early treatment related mortality from GvHD and infection (20-40%)

Risk of long term MDS from BM injury

Less risk of late MDS

Patient receives high dose chemo-(±radio)therapy (conditioning) which ablates the BM and immune system. After conditioning is completed, BM or PBSC are infused IV. After a period of profound myelosuppression (7-25d), engraftment occurs with production of WBCs, platelets and RBCs. Immunosuppression is required after allogeneic transplantation to prevent GvHD and graft rejection.

Early complications of the transplant procedure

Chemoradiotherapy

• Nausea/vomiting.

• Reversible alopecia.

Infection 2gc

• CMV (particularly pneumonitis)*.

• Atypical organisms—Pneumocystis (PCP)*, Toxoplasma*, Mycoplasma*, Legionella*.

*Low risk in autologous SCT; significant to high risk in allogeneic SCT Graft-versus-host disease (GvHD)

May occur in recipients of allogeneic SCT due to tissue incompatibility between donor and recipient undetected by standard tissue-typing tests. Acute and chronic forms occur. Higher incidence of severe GvHD following unrelated donor SCT and mismatched (haploidentical) grafts.

Late complications of transplantation

• Hypothyroidism.

• Secondary malignancy.

• Late sepsis due to hyposplenism.

• Psychological disturbance.

Follow up and post-transplant surveillance

Life-long supervision required. The particular risks and monitoring required depend on the type of graft and whether TBI was used. Suitable conditioning regimens are outlined on p310.

0 0

Post a comment