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Allogeneic stem cell transplantation
ℹ️ About
- 🧬 Allogeneic stem cell transplantation = transfer of haematopoietic stem cells from a healthy donor to a patient
- ⚡ Usually performed after high-intensity chemotherapy and/or radiotherapy to eradicate malignant cells and suppress the patient’s immune system
- 👨👩👧 Donors may be related (sibling) or unrelated volunteers
- 🧪 Requires HLA matching for best outcome
🌱 The Graft
- 🩸 Contains stem cells that are free of malignant cells
- 🛡️ Also includes immune effector cells – T lymphocytes and NK cells
⚔️ Graft Versus Malignancy Effect
- 🔥 Donor immune cells can attack residual malignant cells → graft-versus-leukaemia (GVL) or graft-versus-tumour (GVT) effect
- 🎗️ This immune response reduces relapse risk and improves long-term survival
- 💡 Important advantage of allogeneic over autologous transplantation
⚠️ Graft Versus Host Disease (GVHD)
- 🚨 Donor lymphocytes may attack recipient tissues → skin, liver, gut most commonly affected
- 📈 GVHD risk increases with HLA mismatch between donor and recipient
- 🧬 Key HLA genes: chromosome 6 loci including HLA-DR, HLA-DP, HLA-DQ
- 👨👩 Sibling HLA match probability ≈ 25% (1 in 4); chance rises with larger family size
- 🌍 If no matched sibling: options include HLA-matched unrelated volunteer, partially matched haploidentical relative, or cord blood stem cells
📌 Exam Pearl: Allogeneic transplant provides a curative option in some haematological malignancies due to the GVL effect, but success is balanced by the risk of GVHD.
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