Does anyone have any information about potential increased success with the donor in a donor (allogeneic) stem cell transplant being an identical twin. My father is preparing to be the donor for my uncle. They have conclusively been shown to be identical twins, which I know "should" help the outcome of the transplant. Some numbers I have seen thrown around are quite promising but seeing as there isn't a wide pool of patients that this scenario applies to I have been hard pressed to find decent research.
Any help would be appreciated!
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Re: Donor stem cell transplant from an identical twin?
Hi Twinkies,
An identical twin is considered the ideal donor for a transplant. It is called a syngeneic transplant. Allogeneic transplants are considered potentially curative for myeloma while autologous transplants are not curative. The allo has a graft vs. myeloma effect which is what makes it a potential cure but it comes with the risk of graft vs host disease. A syngeneic transplant has a tumor free graft and a longer remission than auto transplant. Patients that do syngeneic transplant do not get graft vs host disease. The immune system of a myeloma patient is dysfunctional, while your uncle's is not. Your uncle's properly functioning immune system can help keep your father in remission.
"Two large registry analyses have compared the results of syngeneic transplantation with Auto-SCT or Allo-SCT. Gahrton et al89 reported on 25 syngeneic recipients reported to the EBMT and Bashay et al90 reported on 43 subjects reported to the CIBMTR. The outcomes of
syngeneic transplant recipients were superior in terms of lower incidence of relapse / progression, PFS and, for the EMBT patients, longer OS compared to Auto-SCT. A possible explanation for this observation would be the presence of a syngeneic GVM (as demonstrated in animal models, but has not been successfully reproduced in humans) 91,92 or due to absence of contaminating myeloma cells in the donor graft. This latter explanation is not supported by purging results of Auto-SCT.93-96 These results also support the use of syngeneic stem-cell transplantation as consolidation therapy of an initial remission in patients who have identical twin donors."
"Targets of curative donor-derived graft-versus-myeloma (GVM) responses after allogeneic hematopoietic stem cell transplantation (HSCT) remain poorly defined, partly because immunity against minor histocompatibility Ags (mHAgs) complicates the elucidation of multiple myeloma (multiple myeloma)-specific targets. We hypothesized that syngeneic HSCT would facilitate the identification of GVM-associated Ags because donor immune responses in this setting should exclusively target unique tumor Ags in the absence of donor-host genetic disparities"
"Two Ags (DAPK2 and PIM1) had enriched expression in primary multiple myeloma tissues. Both elicited Ab responses in other multiple myeloma patients after chemotherapy or HSCT (11 and 6 of 32 patients for DAPK2 and PIM1, respectively). The index patient also developed specific CD8(+) T-cell responses to HLA-A2-restricted peptides derived from DAPK2 and PIM1. Peptide-specific T cells recognized HLA-A2(+) MM-derived cell lines and primary multiple myeloma tumor cells. Coordinated T- and B-cell immunity develops against MM-associated Ags after syngeneic HSCT. DAPK1 and PIM1 are promising target Ags for MM-directed immunotherapy."
http://www.ncbi.nlm.nih.gov/pubmed/22267603
Mark
An identical twin is considered the ideal donor for a transplant. It is called a syngeneic transplant. Allogeneic transplants are considered potentially curative for myeloma while autologous transplants are not curative. The allo has a graft vs. myeloma effect which is what makes it a potential cure but it comes with the risk of graft vs host disease. A syngeneic transplant has a tumor free graft and a longer remission than auto transplant. Patients that do syngeneic transplant do not get graft vs host disease. The immune system of a myeloma patient is dysfunctional, while your uncle's is not. Your uncle's properly functioning immune system can help keep your father in remission.
"Two large registry analyses have compared the results of syngeneic transplantation with Auto-SCT or Allo-SCT. Gahrton et al89 reported on 25 syngeneic recipients reported to the EBMT and Bashay et al90 reported on 43 subjects reported to the CIBMTR. The outcomes of
syngeneic transplant recipients were superior in terms of lower incidence of relapse / progression, PFS and, for the EMBT patients, longer OS compared to Auto-SCT. A possible explanation for this observation would be the presence of a syngeneic GVM (as demonstrated in animal models, but has not been successfully reproduced in humans) 91,92 or due to absence of contaminating myeloma cells in the donor graft. This latter explanation is not supported by purging results of Auto-SCT.93-96 These results also support the use of syngeneic stem-cell transplantation as consolidation therapy of an initial remission in patients who have identical twin donors."
"Targets of curative donor-derived graft-versus-myeloma (GVM) responses after allogeneic hematopoietic stem cell transplantation (HSCT) remain poorly defined, partly because immunity against minor histocompatibility Ags (mHAgs) complicates the elucidation of multiple myeloma (multiple myeloma)-specific targets. We hypothesized that syngeneic HSCT would facilitate the identification of GVM-associated Ags because donor immune responses in this setting should exclusively target unique tumor Ags in the absence of donor-host genetic disparities"
"Two Ags (DAPK2 and PIM1) had enriched expression in primary multiple myeloma tissues. Both elicited Ab responses in other multiple myeloma patients after chemotherapy or HSCT (11 and 6 of 32 patients for DAPK2 and PIM1, respectively). The index patient also developed specific CD8(+) T-cell responses to HLA-A2-restricted peptides derived from DAPK2 and PIM1. Peptide-specific T cells recognized HLA-A2(+) MM-derived cell lines and primary multiple myeloma tumor cells. Coordinated T- and B-cell immunity develops against MM-associated Ags after syngeneic HSCT. DAPK1 and PIM1 are promising target Ags for MM-directed immunotherapy."
http://www.ncbi.nlm.nih.gov/pubmed/22267603
Mark
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Mark
Re: Donor stem cell transplant from an identical twin?
I have a twin, but we are fraternal 
. My doctor had said that if we were identical, my sister would be the best donor and instead of an auto with my cells it would be better to use my sister's, because you get the benefits of an allo transplant (myeloma free stem cells given back to you), but the recovery is the same as an auto in that there is no rejection. She couldn't say it would be curative, but it would have a good chance of being a long remission.
Alas, we are not identical so I was my own donor. Down the road my siblings may get tested to see if they are potential matches. Our family has a strong resemblence so maybe that is a good sign
. My doctor had said that if we were identical, my sister would be the best donor and instead of an auto with my cells it would be better to use my sister's, because you get the benefits of an allo transplant (myeloma free stem cells given back to you), but the recovery is the same as an auto in that there is no rejection. She couldn't say it would be curative, but it would have a good chance of being a long remission. Alas, we are not identical so I was my own donor. Down the road my siblings may get tested to see if they are potential matches. Our family has a strong resemblence so maybe that is a good sign
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lys2012 - Name: Alyssa
- When were you/they diagnosed?: 2010, Toronto, Canada
- Age at diagnosis: 32
Re: Donor stem cell transplant from an identical twin?
My mum just went into hospital yesterday for transplant tomorrow. This is her second transplant and they are using her identical twin sister's cells this time. Last transplant they 'cleaned' and used her own stem cells. Not sure of the medical terms sorry. This time they will use her twin sister's cells. She was diagnosed 6 years ago. I'll keep you posted.
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Blakey
Re: Donor stem cell transplant from an identical twin?
I am an identical twin and I was the stem cell donor for my twin in 2006. She had an aggressive form of multiple myeloma and the transplant gave her 9 months. She died in June 2007. It seemed so promising that we were identical. Hope a cure is discovered. Best wishes to all.
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Deniseh
Re: Donor stem cell transplant from an identical twin?
A woman I know had a syngeneic transplant in the 1990's. I don't know details of how long she had a remission, but some time around 2009 I know that she had active myeloma again. I don't know what type of multiple myeloma she had prior to the transplant, but I do know that when I met her she had light chain disease. A few years later, her disease mutated and become nonsecretory. The good news is that she is still alive and doing fairly well 20+ years after diagnosis and is responding well to treatment.
All the best to your father for good results from a syngeneic transplant.
Nancy in Phila
All the best to your father for good results from a syngeneic transplant.
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
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