Bone Marrow & Stem Cell Transplantation

High dose chemotherapy with peripheral blood and marrow cell transplant has evolved from an experimental treatment available in only a few research centers to an accepted treatment option for many types of cancer.

Compass Oncology physicians have been involved from the beginning of autologous transplant research in Oregon and Southwest Washington. If your medical oncologist determines that high dose therapy is indicated for the management of your illness, you will be referred to the transplant physician who will discuss transplantation with you and your family and introduce you to the other members of the transplant team.

We partner with local hospitals accredited by the Foundation for the Accreditation of Cellular Therapy (FACT).

What is a Stem Cell Transplant?

A stem cell transplant, sometimes called a bone marrow transplant, is a procedure that restores blood-forming stem cells in the bone marrow. This is necessary when a patient has had their bone marrow damaged by cancer or by cancer treatment. Blood-forming stem cells are important because they grow into different types of blood cells. The main types of blood cells are white blood cells, red blood cells, and platelets. You need all three types of blood cells to be healthy.

When is a Stem Cell Transplant Needed?

Stem cell transplants are used most commonly for patients with blood cancers such as leukemia, multiple myeloma, and some lymphomas. In cancers such as these, high doses of chemotherapy (sometimes in combination with radiation therapy), are administered with the intent of killing the stem cells. This stops the process of making new blood cells and the cells required for your immune system. Once the treatment is complete, the patient will receive a transplant of stem cells from a donor. The cells are administered through the blood and then move to the marrow where they can begin their work of regenerating the necessary blood and immune cells.

Over time, the stem cells that have settled in the bone marrow begin to grow and make blood cells that are healthy. This process is called engraftment.

Types of Stem Cell Transplants

The blood-forming stem cells that are used in transplants can come from the bone marrow, bloodstream, or umbilical cord. 

There are two main types of transplants, which are named based on who gives the stem cells:

  • Autologous (AUTO), where the stem cells come from you, the patient.
  • Allogeneic (ALLO), where the stem cells come from someone else. Donors do not have to be a blood relative, but in many cases, a sibling will have cells that will be compatible with the patients.

Patients who have an identical twin may receive a less common type of transplant, called a syngeneic transplant. In this transplant, the stem cells are taken from the twin as long as both siblings have identical genetic makeup and tissue type.

Autologous

The goal of an autologous stem cell transplant is to restore the body’s ability to make normal blood cells after receiving high-dose chemotherapy or radiation treatment. In this procedure, the patient’s stem cells are harvested (removed) from the bone marrow or the blood before getting treatment that would destroy them. Once the stem cells are removed, they are frozen. After receiving treatment, the stems cells are thawed and given back to the patient.

One big advantage of this type of transplant is that patients are getting their own cells back. This means they aren’t at risk for graft versus host disease -- a medical complication where new stem cells (called the “graft”) attack the body. However, there can still be graft failure, which means the cells don’t make blood cells as they should because they haven’t reached the bone marrow. Additionally, this type of transplant doesn’t offer the benefits of graft versus tumor (GVL) effect, which is when healthy donor cells attack cancer cells.

There are also some adverse side effects to autologous stem cell transplantation, which are mostly a result of the high-intensity conditioning therapy. These effects may include:

  • Higher chance of infection due to decreased blood counts, which may require transfusions of red cells and platelets.
  • Complications, such as interstitial pneumonia, which can be a result of infection or damage from conditioning drugs used during therapy.
  • Painful oral ulcers, which may make eating or drinking difficult.

Autologous stem cell transplants are mainly used to treat certain leukemias, lymphomas, and multiple myeloma. In some cases, it is used for testicular cancer, neuroblastoma, and certain childhood cancers.

Allogenic

People have different sets of proteins, called human leukocyte-associated (HLA) antigens, on the surface of their cells. The set of proteins, called the HLA type, is identified by a special blood test.

When a donor will be the source of stem cells for a cancer patient, the oncologist will aim to match the patient’s own stem cells as closely as possible. This can help minimize side effects.

In most cases, the success of allogeneic transplantation depends in part on how well the HLA antigens of the donor’s stem cells match those of the recipient’s stem cells. The higher the number of matching HLA antigens, the lesser the chance the patient will reject the stem cells.

How Do Stem Cell Transplants Work Against Cancer?

Instead of working against cancer directly, stem cell transplants help the body recover its own ability to produce stem cells after chemotherapy and/or radiation treatment.

With that said, stem cell transplants may work against cancer directly in patients with multiple myeloma and some types of leukemia. For example, a stem cell transplant where stem cells come from another person can also help treat certain types of cancer in a way other than just replacing stem cells. Cells that are donated can often find and kill cancer cells better than the immune cells of the person who had the cancer ever could. This is called the “graft-versus-tumor” (GvT) or “graft-versus-leukemia” (GVL) effect, which simply means that certain kinds of transplants actually help fight the cancer cells, rather than just providing normal blood cells.

Who is a Candidate for a Stem Cell Transplant?

Although some patients could benefit from stem cell transplants, they are typically only used when all other first-line treatments have failed.

Even though stem cell transplants have been successful for many people, it is important to weigh the risks and benefits before making a decision. The cancer care team should talk with the patient about the risks and potential benefits. They may also discuss other methods of treatment available, including clinical trials. Various factors, including the patient’s age, stage of the cancer, donor type, and overall health are all part of the decision-making process.

As with all other types of medical treatment, the final decision is up to the patient regarding whether or not to move forward with a stem cell transplant.

Current Stem Cell Clinical Research Studies

Through stem cell therapy research, cancer stem cells (CSCs) are leading to an encouraging outlook on the future treatment of patients who have been diagnosed with germ cell tumors as well.

Germ cell tumors are growths that form from reproductive cells. They arise in the ovaries (in girls) and the testes (in boys). They can also sometimes occur in other areas of the body, such as the lower back (common in infancy), the abdomen, the chest, and within the brain.

Germ cell tumors may be cancerous or noncancerous. In most cases, cancerous germ cell tumors occur as testicular cancer or ovarian cancer.

Patients whose healthcare providers have recommended a stem cell transplant, should take time to ask questions and get answers before making a decision. It may also be a good idea to have a second opinion regarding a recommended cancer treatment plan. 

Additional information on blood and marrow transplant:

Blood and Marrow Transplant Information Network
A not-for-profit organization dedicated to serving the needs of the transplant community.

National Bone Marrow Transplant Link
A non-profit organization serving bone marrow and stem cell transplant patients, their caregivers, families, and health professionals.

National Marrow Donor Program
Maintains the world’s largest registry of volunteer marrow donors to support patients, referring physicians and the transplant community through the transplant process.

These links are provided as a public service and for informational purposes only; no endorsement is made or implied. The information provided by these sites may supplement but cannot substitute for the individualized recommendations of your physician. Not all active clinical trials are available for Compass Oncology patient enrollment; patients should discuss their eligibility for specific clinical trials with their oncologist.

 

Sources: