What is an allogeneic transplant? Who is eligible for a transplant?

What is an allogeneic transplant? Who is eligible for a transplant? So, allogeneic transplants are transplants where the primary point of it is to get bone marrow from somebody else, bone marrow or blood stem cells from somebody else. So, it's a treatment for a variety of different conditions. There are the major part, the major cancer finding part of an allogeneic bone marrow transplant is getting the immune system of the other person because that immune system is going to kill your MDS or your leukemia or whatever. And so, it's not just chemo, it's this anti-tumor immunity that's the most important part. So, you're supposed to receive that immunity from your donor. That's why an allogeneic transplant. An autologous transplant is you're using your own cells, but when you do that, you get your own immune system and your immune system is not going to fight your cancer because it hasn't fought your cancer yet. So, an allogeneic transplant is there are different ways of doing it and part of it is who you get the stem cells from. It could be from a sibling, it could be from a child of yours, it could be from your parent, it could be from an unrelated person where they do these bone marrow drives, it could be from umbilical cord blood. So, there are different kinds, but the essential thing is getting the cells from some other person than you. So, you undergo the transplant by getting some form of chemotherapy, you get those stem cells and immune system from some other person and then you just wait it out and see what happens. So, the major upside of that is that it can cure a lot of cancers that are where chemotherapy traditionally doesn't work because killing using the immune system is totally different than killing using chemotherapy. So, it can work when chemotherapy doesn't work. The downside of the transplant, the major downside is that just like we want your immune system to attack your cancer, it can start attacking the rest of you and that causes something called graft-versus-host disease and that is probably the most lethal or common complication of the transplant. So, who can get this? So, in general, it used to be that patients who were over the age of 60, 65 were not eligible because it's a pretty dangerous procedure. There have been many advances over time that now allow patients of almost any age, as long as they're in good health, to get an allogeneic bone marrow transplant. What you need is you need a donor, you need to be in good health at the time, right? And you need to find a place that will do it. So, within MDS, within myelodysplastic syndrome, the patients who should get a bone marrow transplant, think about getting a bone marrow transplant, are patients with high-risk MDS. So, you can have MDS split into low-risk and high-risk. High-risk is bad because high-risk oftentimes will make you live a shorter amount of time. And so, what we want to do in those patients is we're willing to tolerate the risk of causing bad problems because they're going to potentially die very soon. In low-risk MDS, patients can live for years and years and years and years and years. So, in those patients, we oftentimes don't do allogeneic transplants because we could kill them in the next six months with a transplant, right? But they might have lived many, many years. And so, for MDS, high-risk MDS are the patients that we focus on the most with allogeneic transplants. There are many great bone marrow transplant centers across the country, and almost all of them will do transplants for MDS. An allogeneic stem cell transplant is when a donor's bone marrow stem cells are harvested and transplanted into a patient who has MDS, AML, or other hematologic diseases. It's a potentially curative option for patients with MDS. It's only for patients who are what we call fit. These are generally younger patients who are in good health. Age has been an issue previously. Many of our MDS patients are diagnosed in their 60s and 70s, so a lot, unfortunately, aren't eligible. However, with advancements in stem cell transplant treatments, we're trying to transplant patients in their 60s, 70s, and sometimes even into their 80s.