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Hematopoietic Cell Transplantation

Hematopoietic Cell Transplantation (HCT)
Why Choose City of Hope?

City of Hope’s Hematopoietic Cell Transplantation (HCT) program is one of the largest and most successful transplant centers in the world. As a pioneer in creating breakthrough treatments for all hematologic cancers and blood-related disorders, City of Hope’s Department of Hematology and Hematopoietic Cell Transplantation (HCT) is a world leader in setting standards for stem cell transplantation and in improving long-term outcomes for both children and adults.

Since City of Hope performed its first bone marrow transplant in 1976, more than 11,000 transplants have been completed for patients from virtually every state and around the world. City of Hope’s HCT program is dedicated to the traditional and newer uses of this procedure.
 
Specialists at City of Hope lead the field of stem cell transplantation with excellent outcomes.Transplant patients at City of Hope have ranged  from younger than one to 79 years old.

City of Hope is renowned for developing innovative transplant regimens that have improved the cure rate for patients with:
 
 
City of Hope’s Hematopoietic Cell Transplantation Program is accredited by the Foundation for the Accreditation of Cellular Therapy (FACT), the gold standard of excellence for blood and bone marrow transplant programs in the United States.
 
HCT Partnership
 
Southern California Kaiser Permanente Medical Center partners with City of Hope to provide stem cell transplantation services to Kaiser Permanente health plan members. Kaiser Permanente patients needing a transplant have their procedures performed at City of Hope. Kaiser Permanente members have full access to City of Hope’s treatment programs, including new therapeutic approaches designed to improve outcomes and cure rates.
 
Physicians from the Kaiser Permanente bone marrow transplant medical group are members of the City of Hope HCT program and work side-by-side with City of Hope staff. These physicians are responsible for all Kaiser Permanente patients under one unified program of patient care.
 
 

FAQs

How many HCTs and PBSCTs are performed at City of Hope?

City of Hope has performed more than 11,000 transplants for patients from virtually every state as well as from numerous countries. HCT and PBSCT patients at City of Hope have ranged in age from less than 1 year old to 79 years old. City of Hope's HCT program is one of America's largest, dedicated solely to the traditional and newer uses of this procedure.

Which diseases are HCT and PBSCT most frequently used to treat?

Allogeneic HCT is used primarily for the treatment of diseases that invade the bone marrow, such as acute and chronic leukemia, myelodysplasia and myeloma. Autologous HCT is used primarily for the treatment of diseases such as lymphoma, Hodgkins disease, acute myelogenous leukemia, myeloma, breast cancer and testicular cancer.

What is the difference between autologous and allogeneic HCT?

Patients receive one of two types of stem cell-based transplants: autologous, in which a patient donates and receives back his/her own stem cells; or allogeneic, in which bone marrow-derived stem cells come from a related or unrelated donor whose human leukocyte antigens (HLA) are genetically matched with those of a patient. Peripheral blood stem cells are generally used in autologous transplantations, while either marrow or peripheral blood stem cells are used in allogeneic transplantations.

How long have HCTs and PBSCTs been done?

This process was first used in the early 1970s. City of Hope's HCT Program began in 1976. City of Hope began performing PBSCTs in 1988.

What are hematopoietic cell transplantation (HCT) and peripheral blood stem cell transplantation (PBSCT)?

HCT and PBSCT are procedures that use stem cells to treat a patient's malignancy or to repair diseased or defective bone marrow. A patient receives intensive chemotherapy with or without total body irradiation therapy in an attempt to kill all cancerous cells, but which also destroy his/her own bone marrow function. This therapy also causes immunosuppression, which prevents rejection of the newly transplanted stem cells from a related or unrelated donor. There is little risk of rejection of a patient's own stem cells following autologous transplant. After transplantation, the new stem cells replace the damaged bone marrow and cells of the immune system.

How do HCT and PBSCT help patients?

HCT and PBSCT allow a patient to receive very high doses of chemotherapy and radiation designed to kill cancer cells. The high doses of therapy lead to the destruction of a patient's own marrow and immune system, which is then replaced by marrow from a donor or from peripheral blood stem cells that have been harvested before therapy.

How are donors for allogeneic transplantations found?

About 30 percent of patients needing a transplant get one from a family member whose HLA testing has identified compatibility between a patient and donor. This matching of donor and recipient reduces the chance of marrow rejection and greatly increases the likelihood of a successful transplant. The remaining 70 percent of patients must find an unrelated donor whose marrow is compatible.
 
Currently, there are nearly 5 million volunteer donors in the National Marrow Donor Program (NMDP) Be The Match Registry. Almost 50 percent of patients searching the registry have at least one identically matched, unrelated donor. The NMDP is conducting a major effort at the 97 donor centers around the United States (of which City of Hope is one) to increase minority registration.
 
As of January 2001, only 25 percent of the potential donors registered were from racial or ethnic minorities. Because HLA types vary greatly between people of different ethnic backgrounds, increasing minority and ethnic representation will increase minority patients' chances of finding matches.

What is bone marrow?

Bone marrow is the soft, spongy material found inside bones. Bone marrow contains stem cells that give rise to white blood cells (to fight infections), red blood cells (for oxygenation) and platelets (to prevent hemorrhaging). The chief function of bone marrow is to produce blood cells.

What are platelets?

Platelets are critical in the clotting process and to help control bleeding. Platelets are commonly used to treat leukemia and cancer patients undergoing chemotherapy and bone marrow transplants. Platelets are also used for trauma patients.

What are stem cells?

All blood cells develop from very immature cells called stem cells. Most stem cells are found in the bone marrow, although some, called peripheral blood stem cells, circulate in blood vessels throughout the body. Stem cells can divide to form more stem cells, or they can go through a series of cell divisions by which they become fully mature blood cells.

What is a mini-HCT?

Mini-HCT is a procedure that allows successful transplant of bone marrow without the use of high-dose chemo and radiation therapy. It is less intensive but allows transplant to be utilized in the treatment of older patients who may not be able to endure the intensity of traditional HCT transplant regimens. Because many diseases, such as leukemia, lymphoma, myeloma and myelodysplasia, are more common in older patients, mini-HCTs allow these patients to potentially benefit from transplant.

Who can donate bone marrow or peripheral blood stem cells?

Donating bone marrow or stem cell to someone suffering from a life-threatening disease is one of the greatest gifts you can provide, the gift of life. The first step is to join the National Marrow Donor Program (NMDP) Be The Match Registry. The NMDP maintains the registry of potential donors and searches this when people need a match. To join the registry, you need to complete a brief health questionnaire, sign a consent form, and provide a small blood sample to determine your tissue type.
 
At City of Hope, we ask that you donate a unit of blood or platelets to help offset the cost of a tissue-type test. Your tissue type will be compared to the tissue types of thousands of patients awaiting a bone marrow transplant. If you are ever a potential match, the City of Hope Donor Center will notify you to see if you are still interested in continuing with the process. If you are, a City of Hope staff member will request an additional blood sample. This sample will determine if the donor matches well enough to continue with the process.

Will patients need blood and platelet donations?

Blood donations from friends and family are a great source of encouragement and support for a patient needing transfusions. If your blood type is compatible with the patient, your donated blood can be given directly to your loved one. If your blood is not the same type, it is still important that you donate to help other City of Hope patients who are a blood type match and seriously in need of your help.
 
In most circumstances, platelet donations do not need be the same blood type. Therefore, most friends and family members can direct their platelet donations to their loved one. Because platelets can only be stored for 3-5 days, consistent support for our patients is crucial. You can help rally friends and family members by sponsoring blood drives for patients as well as arranging for group donations in our Donor Center.
 
Encourage friends and family members to call the City of Hope Blood Donor Center at (626) 471-7171 and schedule an appointment to donate blood and/or platelets or make arrangements for a blood drive in your community. To find a blood drive in your community, please call 626-301-8385.

Why do patients need platelets?

Before a patient receives a donor's marrow, his or her own marrow must be destroyed by a rigorous treatment of chemotherapy and/or radiation. Once the patient receives the donated marrow, it takes about 4 to 8 weeks for the new marrow to produce platelets. During that time period, the patient needs transfusions of platelets to help his/her blood to clot. City of Hope patients sometimes receive platelet transfusion on a daily basis.

What are the risks to marrow donors?

Virtually none. Bone marrow is extracted under general anesthesia in a procedure that takes less than an hour. Donors have commented that their buttocks felt sore for several days after aspiration. Contrary to organ donations, marrow is completely replenished by the body within a couple of weeks. There are no increased risks to the donor during this period. Historically, at HCT centers around the world, marrow has been donated by individuals less than 1 year old to 60 or 70 years old.

What are the possible complications associated with HCT and PBSCT?

Immediately following allogeneic transplantation, patients are immunosuppressed and unable to fight infection. Different drugs are administered during this critical period and isolation is sometimes necessary for the patient.
 
Another possible complication for patients receiving allogeneic transplantation is known as graft-versus-host disease (GvHD). Despite the close match between patient and donor, in GvHD, the donated marrow may recognize its new home as foreign and react against the host.
 
In addition, patients can acquire post-transplant cytomegalovirus (CMV) pneumonia. City of Hope has pioneered several outstanding advances for the prevention and treatment of this potentially fatal complication. Recurrent disease also is possible if the pre-transplant chemotherapy and irradiation therapy were not successful in killing all malignant cells.
 
In autologous transplantations there are few complications once the patient leaves the hospital, and the only risk is whether the disease will return, causing relapse.

Resources

 
City of Hope strives to make the Sheri & Les Biller Patient and Family Resource Center an international model of compassionate care. It is one of the only institutions in the United States to offer this level of comprehensive support — dramatically improving the patient and family experience, as well as the ability of physicians and health care teams to provide exceptional medical care. The Sheri & Les Biller Patient and Family Resource Center embodies the heart and soul of City of Hope’s mission to care for the whole person.
 
In the center, patients and their loved ones find the resources, education and support they need to better manage the challenges related to a serious illness. The Sheri & Les Biller Resource Center also offers a wide array of programs including educational classes designed to better prepare patients and caregivers for treatment, healing arts workshops, peer support groups, educational classes designed to better prepare patients and caregivers for treatment, and much more.
 
The center offers the services of:
 
  • Patient navigators
  • Pain and palliative care physicians
  • Psychiatrists
  • Psychologists
  • Social workers
  • Spiritual care chaplains
  • Child-life specialists
 
What Makes the Resource Center Unique
 
Our SupportScreen system enables new patients to report their psychological, spiritual, emotional, social, rehabilitative, physical and nutritional concerns. Members of the health-care team, such as physicians and nurses, learn about the results of patients’ screenings to ensure that they understand and respond to patients’ physical, psychological, social and spiritual needs.
Patient navigators tailor support services to match the needs of each patient and family. They address needs that are as diverse as patients needing help to deal with pain, to getting transportation to the medical center or overcoming other barriers. Our programs are enhanced by input from the Patient and Family Advisory Council, a consistent voice for the patient and family perspective.
At the Positive Image Center, patients learn how to minimize the cosmetic side effects of illness or medical treatment. They consult with specially trained, licensed cosmetologists who offer guidance about skin care techniques, options for hair loss and much more. The setting is typically more private and soothing than a salon, where patients may be surrounded by people who might not understand their condition, concerns or physical needs.
 
In keeping with our mission to care for the whole person — physically and emotionally — City of Hope is one of the few cancer centers in the country to offer patients and their caregivers temporary, on-site housing in a comfortable, home-like setting.
 
Village Hospice
When cancer cannot be cured, patients and their families are confronted with many complex end-of-life issues. Understandably, many patients wish to spend their remaining days in a home-like setting where they can be with their loved ones — quietly and privately — while remaining close to their medical care team.

Set within our landscaped grounds, City of Hope’s Village Hospice is just such a place. Here, terminally ill patients and their families receive specialized care in garden apartments that include comfortable living quarters, full kitchens and handicapped accessible bathrooms.
 
Village Hospice provides a peaceful environment for patients at the end of life, while preserving the patient’s dignity. The village is supported by Hospice of Pasadena/Presbyterian Intercommunity Hospital’s hospice nurses and physicians and City of Hope staff.
 
'A Patient's Guide' 
  • The book "A Patient's Guide to Blood and Marrow Stem Cell Transplantation at City of Hope" was developed as a resource to help City of Hope patients and their families learn about blood and marrow hematopoietic stem cell transplantation and what to expect before, during and after transplant at City of Hope.

 

 

BMT/HCT Reunions

City of Hope performed its first bone marrow transplant in 1976. Since then, thousands of patients from virtually every state and dozens of countries have undergone bone marrow, cord blood or stem cell transplants at City of Hope.
 
Each year, City of Hope invites bone marrow transplant recipients and their families to attend the "Celebration of Life" event on the Duarte campus. The reunion has grown to more than 6,500 attendees from all over the United States and overseas. The reunion is a joyous day for everyone in attendance — physicians, nurses and former patients — as they celebrate the victories they have attained in fighting cancer. The day also features performances by former patients who entertain their fellow survivors and their families.
 
The patient-donor meeting is an emotional highlight of the event. Each year, two patients who needed to find a donor prior to their transplant meet the individual who eventually saved their lives. These are donors who have registered with the National Marrow Donor Program. It is the first time patients and donors actually meet since the life-saving donation. There are currently one million potential donors on the Be the Match Registry who have volunteered to give the gift of life.
 
Watch videos, view pictures, read stories and learn more about the Celebration of LIfe Bone Marrow Transplant Reunion
 
 
The annual reunion also enables physicians and researchers to advance the science of hematopoietic cell transplantation. Learn more about the Karl G. Blume-Gerhard Schmidt Memorial Lecture in Transplantation Biology & Medicine.
 

Research

A major focus for City of Hope researchers has been creating ways to reduce the incidence of major transplant risks such as infection and relapse. They publish their results in prominent peer-reviewed medical journals.
 
Nonmyeloablative (Mini) Transplants

One of these innovative protocols, nonmyeloablative transplants, has allowed patients who could not tolerate the traditional pre-transplant regiments to become candidates for the procedure.
 
Originally, pre-transplant protocols required high-dose chemotherapy and/or high-dose whole-body irradiation. For elderly patients or patients with other diseases, these protocols were too demanding and often excluded them from transplants.

In order to improve both the safety of transplantation and its applicability to a larger number of patients, City of Hope developed an approach in 1998 for a “mini” transplant. These transplants rely less on the heavy doses of chemotherapy and radiation and more on the antitumor effects of the graft itself (known as a graft-versus-tumor effect).
 
This novel approach has allowed for transplants in patients who are older, including patients in their 70s, who would previously not have been eligible for a transplant. These patients, with conditions such as leukemia, myeloma, lymphoma and myelodysplasia, have been significantly helped – even cured – by mini transplants.
 
SPORE Grant

The City of Hope Hematologic Neoplasia Program was awarded a Specialized Program of Research Excellence (SPORE) grant to further its work in utilizing transplant and non-transplant approaches for the treatment of malignant lymphoma and Hodgkin lymphoma. This SPORE is one of only three SPORE awards granted in the United States and builds upon the expertise in the transplant and cancer immunotherapy programs at City of Hope.
 
National Cancer Institute Project Grant

The City of Hope’s HCT Program has been continuously funded for nearly 30 years by the National Cancer Institute (NCI) to develop innovative therapies for people battling leukemia, lymphoma and other cancers. The NCI grant supports continuing research aimed at improving the outcome for patients undergoing either autologous or allogeneic transplant for hematologic cancer. The grant also allows researchers at City of Hope to develop laboratory-based clinical studies to extend the boundaries of HCT into new areas. These studies include the development of therapies incorporating the emerging sciences of gene transfer, molecular biology, radioimmunotherapy, cellular immunotherapy and genetics into allogeneic and autologous transplant.
 
City of Hope Named Center of Excellence for MDS
 
City of Hope physicians and researchers continue to lead the way in improving treatments and outcomes for patients with myelodysplastic syndromes (MDS). City of Hope’s Clinical and Translational Research Program has had funding for the Hematopoietic Cell Transplantation Program by the National Cancer Institute since 1981. The MDS Foundation recognized City of Hope as a Center of Excellence for MDS in 1998 in recognition of the program’s basic and clinical research. designation.
 
Adoptive T Cell Therapy

T cells are a powerful part of the immune system. A new approach being studied at City of Hope involves redirecting T cells to recognize cancer cells specific to lymphoma and leukemia. Researchers are taking T cells from patients with these cancers and genetically modifying them to target and destroy the malignant T cells. Studies are focusing on patients with recurrent diffuse large cell lymphoma, acute lymphoblastic leukemia  who are undergoing autologous stem cell transplantation.
 
Long-term Follow-up Program
 
City of Hope recognizes the importance of maintaining contact with all transplant patients. Our transplant program established a formal Long-term Follow-up Program in 1998 that follows all patients who have received a transplant at City of Hope. The Long-term Follow-up Program helps researchers compile data on long-term outcomes to increase awareness of the kinds of problems, both physical and psychological, that some patients face after transplant, so patients can receive continuing advice, information and care.
 
 

Blume-Schmidt Lecture

The annual City of Hope Celebration of Life Hematopoietic Cell Transplantation Reunion not only celebrates and commemorates survivors' lives, but also enables physicians and researchers to advance the science of hematopoietic cell transplantation, or HCT.
 
The Memorial Lecture, held each year in association with the annual HCT Reunion, commemorates the work and dedication of the late Gerhard Schmidt, M.D., who joined City of Hope's program in 1977 and established the Autologous Stem Cell Transplant and Histocompatibility Laboratory programs, among many other achievements. Schmidt lost his own battle with cancer in 1993.
 

2013 Lecture

In May 2013, hematology experts from around the country convened at City of Hope for the Blume-Schmidt Memorial Lecture in Transplantation Biology and Medicine to discuss the impact of Karl G. Blume, M.D., the founder of City of Hope's bone marrow transplant program. Blume launched the program in 1975, when such procedures were at the forefront of current science, and regarded as novelties in many circles. Today, that program is a world leader in hematopoietic cell transplantation.
 
 
 
 
As of this year, the lecture, viewable above, is known as the Karl G. Blume-Gerhard Schmidt Memorial Lecture in Transplantation Biology & Medicine.

The presenters and their topics:

Nelson J. Chao, M.D., M.B.A., chief of the Division of Cellular Therapy, Cell Therapy & Hematologic Malignancy Program at Duke University School of Medicine: “MicroRNAs as Biomarkers for GVHD.”

Robert S. Negrin, M.D., professor of medicine at Stanford University Medical Center: “GVHD from the Perspective of the T Cell.”

Frederick R. Appelbaum, M.D., member  and director of the Clinical Research Division at Fred Hutchinson Cancer Research Center and professor and head of the Division of Medical Oncology: “Simpler and More Accurate Prognostic Testing in Acute Leukemia.”

John A. Zaia, M.D., Aaron D. Miller and Edith Miller Chair in Gene Therapy, chair and professor of the Department of Virology, and professor of pediatrics at City of Hope: “Blood Stem Cell Transplantation for HIV/AIDS: Is this the Future?”

Stephen J. Forman, M.D., Francis & Kathleen McNamara Distinguished Chair in Hematology and Hematopoietic Cell Transplantation and chair of City of Hope’s Department of Hematology & Hematopoietic Cell Transplantation:  “T Cell Engineering to Improve the Graft Versus Leukemia Effect.”
 

HCT Team

Support This Program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.


For more information on supporting this specific program, please contact us below.

Tina Pakfar, Ph.D.
Vice President
Direct: 213-241-7216
Email: tpakfar@coh.org

 
 
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About the HCT Program
Stephen J. Forman, M.D., chair of hematology and hematopoietic cell transplantation, shares his views on the essence of care at City of Hope. He highlights the bone marrow transplant program (BMT) and the program's growth over the years.
 
Other videos:
 
Past BMT Reunions
Each year, City of Hope invites bone marrow transplant recipients and their families to attend the "Celebration of Life" event. View highlights from past reunions.
 
Physicians in the United States and throughout the world are welcome to refer patients to City of Hope.

There are a number of options you can choose from to refer a patient:

  • Call 800-826-HOPE (4673) to speak with a patient referral specialist.
  • Fax the patient face sheet to 626-301-8432
  • Complete an online callback request form
 
The focus of the Division of Hematopoietic Stem Cell and Leukemia Research is to improve the understanding of leukemia stem cells in order to develop cures for leukemia and other hematologic malignancies.
City of Hope's partnership with the Los Angeles Dodgers, includes ThinkCure!, an innovative, community-based non-profit that raises funds to accelerate collaborative research at City of Hope and Childrens Hospital Los Angeles to cure cancers.
 
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