While the majority of bone marrow transplants (BMTs) are successful, there are four main reasons why a BMT may fail. Our research in the BMT Unit at Great Ormond Street Hospital (GOSH) centres on a number of areas, which are summarised below.
Toxicity from the chemotherapy and/or radiotherapy in preparation for BMT. GOSH has pioneered a number of reduced intensity transplants in an attempt to reduce both the early and late toxicity of BMT. GOSH is now recognised as world leaders in this field.
Disease relapse and viral infections
GOSH has a number of studies that allow the donor immune system to be specifically targeted to disease (tumour cells) or to viruses.
Adoptive immunotherapy (as described above) allows the benefit of the graft to be maximised while reducing one of the other complications of BMT: graft-versus-host disease (GVHD).
Cord blood transplantation
Cord blood transplantation which, because of less stringency for full tissue type matching, provides suitable donors when no bone marrow donor can be found. Cord blood also appears to provide a new immune system faster than other stem cell sources so helps to fight infection more rapidly.
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Karlsson H, Samarasinghe S, Ball LM, Sundberg B, Lankester AC, Dazzi F, Uzunel M, Rao K, Veys P, Le Blanc K, Ringdén O, Amrolia PJ (2008) Mesenchymal stem cells exert differential effects on alloantigen and virus-specific T-cell responses. Blood 112 (3): 532-41
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Booth C, Gilmour KC, Veys P, Gennery AR, Slatter MA, Chapel H, Heath PT, Steward CG, Smith O, O'Meara A, Kerrigan H, Mahlaoui N, Cavazzana-Calvo M, Fischer A, Moshous D, Blanche S, Pachlopnick-Schmid J, Latour S, de Saint-Basile G, Albert M, Notheis G, Rieber N, Strahm B, Ritterbusch H, Lankester A, Hartwig NG, Meyts I, Plebani A, Soresina A, Finocchi A, Pignata C, Cirillo E, Bonanomi S, Peters C, Kalwak K, Pasic S, Sedlacek P, Jazbec J, Kanegane H, Nichols KE, Hanson IC, Kapoor N, Haddad E, Cowan M, Choo S, Smart J, Arkwright PD, Gaspar HB (2011) X-linked lymphoproliferative disease due to SAP/SH2D1A deficiency: a multicenter study on the manifestations, management and outcome of the disease. Blood 117 (1): 53-62
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