New techniques recently described in The New England Journal of Medicine may improve the odds of success for bone marrow transplants.
In one study, bone marrow transplants were successful even when the match between donor and recipient was less than perfect. The second study showed that genetic analysis can be used to improve success even when the marrow of the donor and recipient is considered a match.
"It is clear that these two studies are milestones in our quest to find bone marrow donors for all our patients," Jon J. van Rood, MD, PhD, of Leiden University Medical Center in the Netherlands wrote in an editorial (1998;339:1238-1239). However, he added that "many other milestones will have to be passed before not only all patients have donors, but also all are cured."
In the first study (1998;339:1186-1193), Franco Aversa, MD, and colleagues at the University of Perugia in Italy and at the Weizmann Institute in Israel transplanted larger-than-normal amounts of stem cells into 43 leukemia patients whose bone marrow had one full haplotype mismatch with the donor marrow. The authors said that "full donor-type engraftment was achieved," and none of the evaluable patients developed graft-versus-host disease. At a median follow-up of 18 months, 12 of the 43 patients were alive and disease-free.
In the other study (1998;339:1177-1185), Takehiko Sasazuki, MD, PhD, of Kyushu University in Fukuoka, Japan, and coauthors retrospectively performed DNA typing in 440 recipients of serologically identical marrow from unrelated donors. Eighty percent of the recipients had leukemia. The results showed that "genomic typing of class I HLA alleles adds substantially to the success of transplantation of hematopoietic stem cells from unrelated donors, even if the donors are serologically identical to their recipients with respect to HLA-A, B, and DR antigens."
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