Hematopoietic stem cell transplantation for lymphoma

If you are unfortunate enough to have lymphoma, please treat it actively. Because there are many treatment methods available. First of all, chemotherapy is very effective. If the lymphoma is advanced, especially if it invades the bone marrow, chemotherapy cannot cure it, so it is recommended to receive bone marrow transplantation, preferably between relatives, or if there is no donor who is fully compatible, semi-compatible bone marrow transplantation between relatives, also called haploidentical bone marrow transplantation. In the 1960s and 1970s, allogeneic bone marrow transplantation, a radical treatment for various types of malignant hematological diseases, was carried out at home and abroad. This traditional bone marrow transplantation requires an exact HLA antigen match between the donor and recipient, i.e., a mutually matched bone marrow donor. Usually, a donor is said to be fully compatible with the patient when all 6 immune markers (3 pairs) of leukocyte antigens are matched, with a 1 in 4 chance of full compatibility between siblings and a 1 in 100,000 chance of compatibility between donors and recipients in the unrelated general population. Therefore, not every patient has a chance to match with a fully compatible bone marrow. 30-40% of patients abroad have no compatible bone marrow source, and the percentage is even higher in China, because China implements family planning and most of them are one-child families, so it is impossible to have siblings to provide compatible bone marrow. As a result, many patients are deprived of the opportunity for radical treatment. Therefore, the solution of the bone marrow source problem is relentlessly in front of hematologists. Since half of the human genes come from the father and the other half from the mother, half of the immune markers between the two generations must be compatible, and the selection of such bone marrow for transplantation is haplotype compatible bone marrow transplantation. In May 1999, the first haploidentical bone marrow transplantation in China was successfully carried out in the Department of Hematology of the Air Force General Hospital, and the child, Chen, received the bone marrow donated by his mother. To date, the boy with acute lymphoblastic leukemia, who had undergone dozens of chemotherapy treatments and relapsed four times with central nervous system invasion, has survived 9 years without disease. In recent years, the Department of Hematology at the Air Force General Hospital has worked with domestic and international hematologists to research and design a protocol with a high implantation rate and a low incidence of severe graft-versus-host disease, making it possible to cross the human HLA incompatibility barrier. At present, hundreds of hematology patients from all over China have successfully received haplotype-compatible bone marrow transplantation, with an implantation rate of 98%, a severe GVHD incidence rate of less than 20%, and a 5-year survival rate of about 50%. The successful development of haplotype-identical bone marrow transplantation has greatly broadened the scope of bone marrow sources, including the patient’s parents, children and siblings who meet the same chromosome, which makes the dream of bone marrow donation between two generations or even between cousins a reality. So every patient can find a donor. This has solved the problem of insufficient bone marrow sources and brought bone marrow transplantation into a new era. The technical requirements of haploidentical bone marrow transplantation are higher than those of all-matched bone marrow transplantation, and the implantation success rate is basically the same as that of conventional transplantation, except that the growth rate of the implanted cells and the recovery of the body’s immune function are slightly delayed, and the graft-versus-host disease may be more obvious, but this is precisely the process by which the anti-tumor effect is exerted, so the disease recurrence rate after haploidentical bone marrow transplantation may be lower. Currently, HLA-all-matched donors are still the preferred bone marrow source, and if an all-matched donor cannot be found, patients may opt for haplotype-adjacent bone marrow transplantation. This technique is used for the treatment of various leukemias, including some refractory relapsed highly malignant lymphomas, myelodysplastic syndromes, aplastic anemia, thalassemia, etc. It has significantly improved the prognosis of such patients and brought new hope to families with blood disorders.