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What are the most important spinal conditions?

Hematological diseases are not very frequent. Probably the most important pathologies are multiple myeloma, lymphomas and acute leukemias. Transplantation is a therapeutic procedure that may be indicated in all these diseases, but not at the same time as the disease.

In the case of lymphomas and myelomas, which transplant is the most used?

There are other diseases where the most frequently used transplant is autologous, with cells from the individual. This is the case of lymphomas and myelomas. In myeloma, also in young patients, we use autologous transplantation to improve the response to the first line of treatment. In lymphomas, normally, the transplant that is considered is also the autologous one. They are performed in patients who have failed first-line treatment or have been given it and have not responded well, or if they have subsequently relapsed on that second line of treatment, we prescribe the transplant.

What is the patient profile?

It can be very varied, because at the present time age can be an exclusion criterion for transplantation, but sometimes we consider not only the chronological age of the patient, but also their biological age, because there may be a young patient with many associated diseases. and older patients who do not have any pathology.

And the donors?

Yes, there are inclusion and exclusion criteria that depend somewhat on the type of donor. There are several, the first one we look for is that the patient has a compatible sibling, because it is the family member that has the best chance of being the right donor for the patient. If you don’t have that sibling, then we look for what we call unrelated donors, who are altruistic donors who have registered with some of these international bone marrow donor registries.

They also use so-called haploid donors. Who are they?

They are family donors who share half of the HLA system, which is the system we look at to see the histocompatibility between donor and recipient with the patient. Haploidenticals are usually relatives: parents, children, and perhaps a distant relative as well.

Which patients have the best prognosis?

The transplant evidently does not cure one hundred percent of the transplanted patients. The most important reason why there are patients who are not cured is because there are times when the disease reappears after the transplant. And the other is that the patient dies due to the toxicity of the therapy, which is what we call mortality related to the procedure. The prognosis depends on a conglomerate of factors.

In the State, how are these types of donations and transplants?

If one looks at the records made by the European Transplant Group in its annual publications, and if we talk about autologous transplants, Spain is among the countries with the most transplants in Europe; If we talk about allogeneic, there is a European country that reports a higher number, but we are in the second step. If we speak by Autonomous Communities, transplant patients in Spain depend on each territory. We have many Transplant centers, both autologous and allogeneic, as well as family or unrelated donors, but there are Communities where there are no Transplant centers and patients must go to the nearest one to have it done. The transplant rate per hundred thousand inhabitants and per year depends on each Community.

Is there fear of donating because it is painful and dangerous for the donor?

There is nothing harmless in this life, not even taking an aspirin. This must be taken into account. Obviously, the donor cells have to be collected from somewhere. Many years ago, most donations from hematopoietic progenitors were made with a bone marrow extraction. For the donor, this meant a hospital admission of two days, with local, general or epidural anesthesia. Medullary blood was drawn from the celiac cells, which are the bones that are in the hip, both the anterior and posterior ones, to achieve a determined volume. These were the cells that we then infused into the patient in question. Since the mid-1990s, instead of using bone marrow, hematopoietic progenitors collected from peripheral blood began to be used, which, also under normal conditions, has very little and we must stimulate the bone marrow to release progenitors into peripheral blood in large quantities. . We collect this with an apheresis machine, which is like a dialysis machine, which extracts the donor’s blood through a catheter so that it circulates inside the machine and separates the layers of progenitor cells, to then return the blood to the donor. rest of the blood.

Is the procedure done on an outpatient basis?

Yes, it is done in a sterile closed circuit, of course, and it is carried out on an outpatient basis with one or two sessions. One is done a day and on consecutive days, and the donor. It is not a painful process, although it is tedious, because it takes a few hours connected to a machine. It is a very safe procedure, although some complication can always arise, but the optimization of peripheral blood cells for the donor has a series of advantages because it is an outpatient process, you do not need to enter or anesthesia. It also has some advantages for the patient, because recovery after transplantation is faster when peripheral blood is used. Obviously, a person who does not know what a donation is like can always be afraid of the unknown, but Spain is really a country where a lot of good work is done on donation of hematopoietic progenitors. We have a very large number of donors.

How would you encourage donating? Do we need more campaigns in schools, from institutions and in the media?

The campaigns usually have a good response. I think it is very important to campaign for donation, so that people, if they meet the inclusion criteria, become an altruistic donor of hematopoietic progenitors, because not everyone can be, given a series of certain criteria.

What kind of criteria?

People over the age of 40 cannot be unrelated donors; you can donate to your brother, but they will not take you as a donor in any of the registries. But, in any case, it is important to campaign, to explain that everyone who can become a donor. Another thing to keep in mind is that the campaigns have to be global. Those focused on a specific patient, as has happened on some occasions, are complex because each of the donors must be studied, a complete analysis performed, viral serologies… These massive campaigns specific to a specific situation entail a series of difficulties. But yes, obviously it is necessary to encourage people, with all the information and being able to ask whatever they want and understanding the procedure well, to become a donor of hematopoietic progenitors to eventually be able to transplant a patient who needs it, both in Spain as it were.

Is leukemia genetic?

No. Most of the hematological diseases are not hereditary. It is true that in some certain situations it has been seen that there are more cases than would be expected in a specific family, but in most of these ailments there is no genetic behavior. They are not infectious diseases that one can transmit to his children or that a child can transmit to his parents. Yes, there are a number of external causes that can potentially trigger it.

What causes?

Radiation, previous chemotherapy for other reasons. But really, we almost never know why a patient develops a hematological disease and not his neighbor. Overall, the cause of hematologic diseases is unknown.

Will there be a day when there is no need for a bone marrow transplant because the genetic correction that produces leukemia can be edited?

No. Most blood diseases are not hereditary diseases. With which, in this case it is not a question of genetic manipulation of the embryo during a pregnancy as advocated in other situations, because they are not inherited diseases. Ideally, the transplant has its complications and toxicities, both early and late, patients who die in the procedure, so we should work on therapeutic strategies that have the capacity to cure and that are more directed at the disease and do not have so many side effects. . But at the moment, despite all the new drugs that exist, there are many hematological diseases and the number of transplants in Europe, both autologous and allogeneic, continues to increase year after year.