Identification of a Suitable Donor

Donor choice can have a profound influence on transplant outcome. Patients may receive either autologous or allogeneic stem cells. Pros and cons of each donor source are displayed in Table 6.1.

Autologous Transplantation

A major issue facing investigators surrounding autologous transplantation is the potential of tumor cell contamination. The aim of purging in autologous transplantation is to eliminate any contaminating malignant cells and leave intact the hematopoietic stem cells that are necessary for engraftment. Most clinical studies in lymphoma and myeloma have demonstrated that purging can deplete malignant cells in vitro without significantly impairing hematologic reconstitution,75-77 but studies in AML using immunologic or chemical methods have been associated with delayed hematopoietic recovery (Figure 6.2).78,79 The rationale for removing tumor cells from hematopoietic cells might therefore appear compelling, yet the issue of purging remains highly controversial. Both positive (CD34+ columns) and negative (exposure ex vivo to antibodies directed at tumor cells) selection techniques for tumor cell purging are available. However, purging has not as

Event Free Survival After ABMT

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