How to chose between Autologous and Allogeneic Marrow Transplant?
The choice of performing autologous versus allogeneic transplant in patients with hematolymphoid malignancies depends, in part, on the disease being treated, its response to conventional-dose chemotherapy, and the availability of a histocompatible donor.
When to chose Autologous Transplant?
In general terms, autologous transplant is recommended for patients whose malignancy exhibits chemosensitivity to conventional dose therapy and does not extensively involve the marrow; included are many of the histologic subtypes of lymphoma including Hodgkin Lymphoma, germ cell tumors, and other selected pediatric tumors. In these instances tumor eradication is a result of dose escalation of cytotoxic therapy in the transplant regimen, and the autograft serves as hematopoietic cell rescue.
When to chose Allogeneic Transplant?
In contrast, allogeneic transplant is generally pursued for hematologic malignancies and disorders that primarily originate in the marrow, such as acute and chronic leukemia, aplastic anemia, and the myelodysplastic and myeloproliferative syndromes. For some diseases with extensive marrow tumor involvement, such as the low-grade lymphomas and myeloma, the decision to pursue autologous or allogeneic transplant is more complex. In general terms, in these settings allogeneic transplant has been more successful in controlling disease recurrence and has been associated with a significant reduction in disease relapse risk. However, the risks associated with allogeneic transplant, which include Graft versus host disease, increased infections, and regimen toxicities are significant and negatively impact the overall survival of patients.
A variety of acquired nonmalignant and congenital disorders can be successfully treated with transplant. Most notable is allogeneic transplant for patients with severe aplastic anemia. For patients with severe combined immunodeficiency syndrome and other congenital lymphoid immunodeficiencies, allogeneic transplant remains the treatment of choice.
Thus, the decision to pursue an allogeneic or autologous transplant for patients with these diseases depends on the combination of patient characteristics such as comorbidities and age, availability of a suitable donor, disease-specific characteristics, and often patient preference.