A Guide to Bone Marrow Transplantation by H. Joachim Deeg M.D., Hans-Georg Klingemann M.D., Gordon L.

By H. Joachim Deeg M.D., Hans-Georg Klingemann M.D., Gordon L. Phillips M.D. (auth.)

In 1988 we offered our advisor to Bone Marrow Transplan­ tation. The reception has been enthusiastic and we have now re­ ceived a flood of severe reviews, feedback and requests to supply an replace in due time. even though a number of books on marrow transplantation have lately been released, their scope and aim have typically been varied. accordingly, we have now determined to organize a moment variation of the consultant. Our target used to be to take care of a brief, concise textual content which by no means­ theless may comprise alterations that experience happened during the last 4 or 5 years. we've streamlined the outline of pretransplant concerns, through condensing sections into one (Treatment making plans and Timing of Transplantation). This additionally facilitated the evaluate of arguable symptoms for marrow transplantation, for instance in sufferers with acute myelogenous leukemia in first chemotherapy-induced remission. we've up-to-date the bankruptcy facing conditioning regimens and feature improved the part on donor choice, specifically in regard to the present point of tissue typing and the identity of unrelated volunteer donors. within the bankruptcy on assortment, processing, and infusion of marrow, we have now integrated fresh advancements, for instance, using closed platforms for marrow harvesting and processing and using strong section separation of stem cells.

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From a cost/benefit standpoint this is understandable. However, it is of no help to the individual patient. Therefore, a sound approach for any physician taking care of a potential marrow transplant candidate would be to call several marrow transplant centers, perhaps one nearby and (if different) one of the large centers, in order to form for himself an opinion as to what the best approach for his patient may be. 28 Pre transplant Considerations References Appelbaum FR, Barral J, Storb R, Fisher LD, Schoch G, Ramberg RE, Shulman H, Anasetti C, Bearman I, Beatty P, Bensinger WI, Buckner D, Clift RA, Hansen JA, Martin P, Finn B, Petersen FB, Sanders JE, Singer J, Stewart P, Sullivan KM, Witherspoon RP, Thomas ED (1990) Bone marrow transplantation for patients with myelodysplasia.

It is important to guard against the possibility that the enthusiasm of a member of the Transplant Team might subtly influence a patient to accept a transplant rather than more conventional therapy. Such acceptance of marrow transplantation on less than reasonable grounds is particularly undesirable since marrow transplantation is still plagued by high intrinsic morbidity and (more variably) mortality rates, to say nothing of expense. When informed consent is obtained, it should be fully documented and witnessed; the patient should be given ample opportunity for questions and - if necessary - withdrawal.

The decision as to who else in the family should be typed and at what level typing should be carried out must be arrived at after a discussion with an expert in an HLA laboratory, ideally at a marrow transplant facility. Although most transplants carried out and reported to date have involved HLA-identical donors, the possibility of marrow transplantation should be considered even if no HLAidentical family member can be identified. The number of HLA-nonidentical transplants carried out at various centers is growing rapidly.

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