Auto Stem Cell Transplant for MCL

I liken maintenance to automobile maintenance: at a certain point, something will need to be changed or replaced. This could mean that the disease has relapsed or is progressing, and that a different maintenance drug might be needed. This of course opens the door of uncertainty. The plus of maintenance is that new drugs and therapies (even CAR-T) are rapidly developing and more effective/less toxic options may exist in the future when you need them.

I underwent a haploidentical transplant, with my son as donor. It has not been terribly easy, but my choices were transplant, or palliative care and hospice. Thus, the decision was very easily made, but ultimately more difficult to live with. Auto transplants avoid the specter of Graft-versus-Host-Disease (GvHD), which itself can be fatal. Auto transplants are generally tougher going into and easier coming out of than allogeneic transplants, as your marrow must be essentially destroyed and completely replaced by the transplanted cells. With anyresidual disease, this means that you will have no immune system to fight it until your cells are engrafted and maturing in the marrow. Everything can be a toss-up.

In allo transplants, it is acceptable to leave some marrow functioning, which provides a modicum of immune system during the transplant time frame. The donor cells normally replace your own cells over time, although many go on two have two different marrows side-by-side so to speak. All of this is avoided in an autologous transplant. What would sway me is the numbers regarding progression free survival, overall mortality and the development of co-morbidities. Remembrer also that if you undergo an auto ytransplant and relapse, new therapies of even an allogeneic transplant remain in the table.

An excellent resource is www.bmtinfonet.org/ as they cover all aspects of transplant, from preparation to long-term survival.

Happy to be of any help I can.