Bone Marrow and Blood Stem Cell Transplant Treatments
We recognize the importance of maintaining contact with all transplant patients to ensure optimal outcomes after treatment. Established in 1998, our long-term follow-up program is available to all patients who have received a transplant at City of Hope. Through this program, our survivors can be carefully monitored for long-term effects and given timely interventions, while our clinicians and researchers have access to data that can further improve cancer treatments.
Our physicians have extensive experience performing a wide variety of transplant procedures, having performed more than 14,000 transplants — making City of Hope one of the largest programs in the United States.
Our expertise includes autologous and allogeneic stem cell transplants (using cells directly from the patient and another person, respectively), using cells derived from bone marrow, peripheral blood, and cord blood.
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 destroys his/her own bone marrow function. This therapy also causes immunosuppression, which prevents the 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 an autologous transplant. After transplantation, the new stem cells replace the damaged bone marrow and cells of the immune system.
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.
City of Hope has performed more than 14,000 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 one 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.
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, Hodgkin's disease, acute myelogenous leukemia, myeloma, breast cancer, and testicular cancer.
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.
About 30% of patients needing a transplant gets 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% of patients must find an unrelated donor whose marrow is compatible.
Because HLA types vary greatly between people of different ethnic backgrounds, increasing minority and ethnic representation will increase patients' chances of finding matches.
There are nearly five million volunteer donors in the National Marrow Donor Program (NMDP) Be The Match Registry. Almost 50% 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.
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 transplants to be utilized in treating 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 transplants.
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.
Platelets are critical in the clotting process and 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.
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.
Donating bone marrow or stem cells 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 must 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 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 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 the process.
Blood donations from friends and family are a great source of encouragement and support for a patient needing transfusion. 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 are seriously in need of your help.
In most circumstances, platelet donations do not need to 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 three to five days, consistent support for our patients is crucial. You can help rally friends and family members by sponsoring blood drives for patients and arranging 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.
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 four to eight 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 may receive platelet transfusions daily.
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, the body completely replenishes marrow within a couple of weeks. There are no increased risks to the donor during this period. Historically, at HCT centers around the world, the marrow has been donated by individuals less than one year old to 60 or 70 years old.
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 to prevent and treat this potentially fatal complication. Recurrent disease also is possible if the pre-transplant chemotherapy and irradiation therapy are 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.