Bone Marrow & Stem Cell Transplant
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The experts at the Indiana University Health Melvin & Bren Simon Cancer Center have the knowledge and experience to diagnose and treat your bone marrow-related cancer. Following diagnosis of certain cancers and blood disorders, we use bone marrow or blood stem cell transplants to treat a variety of conditions. These transplants are for cancers of the blood and some solid cancers that generally require aggressive treatment, including:
- Leukemia. We treat a variety of types of leukemia (cancer of the blood cells), including acute myeloid leukemia, acute lymphoblastic leukemia, chronic lymphoblastic leukemia, chronic lymphocytic leukemia and chronic myelogenous leukemia. Leukemias are types of cancers that consist of different blood stem cells and white cells.
- Non-Hodgkin lymphoma. This is cancer of the lymphatic system, which is an important part of the immune system. It can form tumors in lymph nodes and bone marrow and can also spread to other organs.
- Hodgkin disease. Hodgkin disease is a particular subtype of lymphoma (cancer of the lymphatic system) that causes cells in the lymphatic system to abnormally reproduce, forming tumors in lymph nodes and bone marrow, sometimes invading other organs.
- Multiple myeloma. This cancer is also of immune cells called plasma cells. It typically affects bone, causing bone pain or fractures, as well as the bone marrow, causing anemia and other abnormalities in the blood counts. It typically produces an abnormal protein (called M protein), which can cause damage to the kidneys, nerves and potentially other organs.
- Myelodysplastic syndromes. Myelodysplastic syndromes, often known as bone marrow failure disorder, are a group of diverse bone marrow disorders of stem cells in which the bone marrow does not produce enough healthy blood cells, and that are often preleukemic (can evolve into acute leukemia).
- Myeloproliferative disorder. Myeloproliferative disorder includes a number of diseases of bone marrow stem cells in which the bone marrow makes too many red blood cells, platelets or certain white blood cells. They can also be associated with severe scarring of the bone marrow and lead to bone marrow failure.
- Aplastic anemia. This blood disorder occurs when the bone marrow fails and produces too few of all three types of blood cells: red blood cells, white blood cells and platelets.
- Germ-cell tumors. Germ-cell tumors occur most commonly in the testes and affect younger men. Less commonly, they can also affect the ovaries in women, or rarely arise from other locations in the body. These cancers are not blood cancers, but can rapidly spread through the blood to affect other organs. Although most can be cured without transplants, patients with resistant cancers may undergo transplantation.
Transplants provide stem cells from which new marrow can regenerate after bone marrow damage from high-dose chemotherapy used to treat the underlying cancer, or resulting from disease. In addition, transplants from another donor provide donor immune cells that can directly fight your cancer.
Bone marrow is a sponge-like, liquid tissue found inside bones that produces blood cells. Stem cells are found in bone marrow and can be made to circulate in higher number in the blood, from which they can be collected. Another source of stem cells is umbilical cord blood (the blood in the cord connecting a fetus to a placenta). Stem cells are often now collected from blood; however, depending on the condition being treated, they may instead be collected from bone marrow.
Stem cells develop into the three main types of blood cells, including red blood cells (which carry oxygen through the body), white blood cells (to fight infection) and platelets (which help the blood clot). Stem cells also reconstitute many other cell types of the immune system.
We obtain blood stem cells using apheresis, a process similar to that used for collecting blood from blood donors. In this process:
- The donor (or the patient, if his/her own stem cells are being used for transplant) is connected to a special cell-separation machine via a needle in the arm or a special intravenous line called a central venous catheter.
- Blood circulates though the machine to remove the stem cells.
- The remaining blood and plasma is returned back to the donor or patient through the opposite arm or the central venous catheter.
- If not enough stem cells are collected the first day, additional days of collection may be needed.
The IU Health Melvin & Bren Simon Cancer Center Bone Marrow & Stem Cell Transplant team primarily treats adult patients. We provide hundreds of bone marrow and stem cell transplants each year to patients who are referred from throughout Indiana, the United States and the world. Pediatric patients receive stem cell transplant treatment at Riley Hospital for Children at Indiana University Health.
Our multidisciplinary transplant team includes doctors, bone marrow transplant nurse coordinators, social workers, physical therapists, occupational therapists, pharmacists and others. IU Health Simon Cancer Center is a member of the National Bone Marrow Program and is accredited by the Foundation for Accreditation of Cellular Therapy (FACT).
In preparation for bone marrow or blood stem cell transplant, we use high-doses of chemotherapy alone, or a combination of high-doses of chemotherapy with total body radiation, to destroy cancerous cells. These methods also destroy healthy cells, including those in the bone marrow, which may cause side effects. Side effects get better and go away after a few weeks.
Once this preparatory treatment is complete, we transplant new stem cells through the veins, after which they find their way to the bone marrow. These stem cells mature into healthy marrow, which produces healthy blood and immune cells.
Stem cells used in a bone marrow or blood stem cell transplant procedure typically come from one of two sources: your own marrow (autologous) or a donor’s marrow (allogeneic). Whether autologous or allogeneic stem cells are used depends on the condition being treated.
Autologous Stem Cell Transplant
Autologous transplantation uses your own stem cells. Before chemotherapy, we collect stem cells from the blood by apheresis. The cells are frozen with a preservative and stored until they are needed. Stem cells can be stored in this way for many years. In a transplant procedure, the stem cells are infused in the vein like a blood transfusion after chemotherapy is complete. Because the cells are your own, there is no risk of your body rejecting the transplanted stem cells.
We use this method mostly for:
- Blood-related cancers (e.g., Multiple myeloma, non-Hodgkin lymphomas, Hodgkin disease)
- Certain solid tumor cancers (germ-cell tumors, testicular germ-cell cancer and ovarian germ-cell cancer)
Allogenic Stem Cell Transplant
The second possible source for healthy stem cells is a donor, usually a sibling or a well-matched unrelated donor from the national registry. Less commonly, when a matched sibling or unrelated donor cannot be found, cord blood stem cells or a mismatched relative donor can be used. This procedure involves harvesting (collecting) stem cells from the blood by apheresis or from the bone marrow (usually from the hip bone) under general anesthetic in the operating room.
We use this method mostly for:
- Blood-related cancers (e.g., acute and chronic leukemia, and less commonly, lymphomas and multiple myeloma)
- Bone marrow failure disorders (e.g., myelodysplastic syndrome, aplastic anemia)
Allogeneic transplants are generally used when an immunological effect against your cancer is thought to be important for curing it. The procedure for transplant into your bones is essentially the same as in autologous transplants. However, an important difference in allogeneic transplants is that medicines used to suppress the immune system are used to prevent rejection and prevent the donor’s immune system from attacking your normal body tissues (a condition called graft-versus-host-disease). After either form of transplant, the goal is that you return to your normal activities with few weeks or months with few, if any, lifestyle changes.
The IU Health Simon Cancer Center combines clinical transplantation services with innovative clinical and basic research to improve the results of transplants and reduce the risk of complications. Clinical research may allow you to participate in clinical trials, so that you can take a more active role in your own healthcare, as well as access new treatments and help others by contributing to medical research. Our basic research continues to increase the amount of knowledge on bone marrow and stem cell transplants.
As part of the IU Health Academic Health Center, research is an important priority to the IU Health Simon Cancer Center Bone Marrow & Stem Cell Transplant Program. In partnership with the Indiana University School of Medicine, our accomplishments include the following:
- We pioneered the use of autologous transplant for treatment of germ cell tumors. These cancerous tumors are growths that typically form from cells that develop into reproductive cells, including the testicles in males (testicular cancer) or ovaries in females (ovarian cancer).
- We are a leader in stem cell biology and umbilical cord transplant. Stem cell biology uses cord blood, which is taken from the umbilical cord at birth. The first cord blood ever used for transplantation was processed and stored at the IU Health Simon Cancer Center.
Our program is at the forefront of clinical trials for treatments for blood cancers. Some of the current trials are focused on:
- Graft-versus-host-disease (GVHD). Graft-versus-host-disease is a side effect of allogeneic bone marrow transplant. Because this type of transplant uses blood cells from a donor, GVHD occurs due to differences between the cells of your body and the immune cells of the donor. New medicines are being tested to minimize this complication.
- Alternative or mismatched donor transplants. Our team members at the IU Health Simon Cancer Center are researching the potential for alternative types of donors, including mismatched donors, umbilical cord blood donors and haplocompatible donors, such as a parent or mismatched sibling.
- Improved results from donor transplants. Donor transplants, especially from cord blood, carry a risk of rejection of the donor marrow, or slow engraftment and recovery. New medicines are being developed to overcome this problem, and we are conducting trials with these medicines to improve results and minimize complications.
- Stem cell biology. This involves the scientific study of cells from which other cell types can develop.