Where the stem cells come from determines the transplant type, the risk profile, the preparation needed and much of the cost. Here is how the four differ and when each is chosen.
Where the stem cells come from determines the transplant type, the risk profile and much of the cost.
| Type | Graft source | GVHD risk | Principal indications | Indicative cost |
|---|---|---|---|---|
| Autologous | The patient's own cells, cryopreserved | None | Multiple myeloma; relapsed lymphoma | $30,000–50,000 |
| Allogeneic | HLA-matched sibling or registry donor | Moderate | Acute leukaemia; thalassaemia; aplastic anaemia | $40,000–60,000 |
| Haploidentical | Half-matched parent, child or sibling | Higher, manageable | Any allogeneic indication without a full match | $50,000–70,000 |
| Cord blood | Banked umbilical cord unit | Lower for the degree of mismatch | Children; rare HLA types; urgent cases | $50,000–70,000 |
Figure 3. A fully matched allogeneic transplant. All ten HLA markers correspond, which minimises both rejection and graft-versus-host disease.
Figure 4. A haploidentical transplant. Every biological parent and child shares exactly half the HLA markers, so a donor exists for nearly every patient with a living close relative.
Typing the patient and all full siblings locally is the single most useful preparation you can make. It frequently determines both the transplant type and the cost, and saves several weeks after arrival.
Stem cells are collected from the patient before high-dose chemotherapy, frozen, and returned afterwards to rescue the marrow. Because the cells are the patient's own there is no graft-versus-host disease and no donor search.
Principally used in multiple myeloma and relapsed lymphoma. It extends remission rather than curing the disease, and is normally followed by maintenance therapy.
Stem cells come from a donor whose HLA markers match the patient's, most often a full sibling. Each full sibling has roughly a one-in-four chance of matching.
The first choice in acute leukaemia, thalassaemia major and aplastic anaemia. It carries a moderate risk of graft-versus-host disease, and with it the therapeutic graft-versus-tumour effect in blood cancers.
Every biological parent and child shares exactly half the HLA markers, so a donor exists for nearly every patient with a living close relative. Post-transplant cyclophosphamide has made these transplants far safer than they once were.
India runs among the largest haploidentical programmes in the world. This is why very few patients here are declined for want of a donor.
Stem cells from a banked umbilical cord unit tolerate a greater degree of mismatch than adult donor cells, so a usable unit can often be found when no donor can.
Mainly used in children and in patients with rare HLA types, or where a transplant is urgent and no donor search can be completed in time.
HLA typing of the patient and full siblings usually answers it. Send what you have and we will tell you what is still needed.