Understanding stem cell transplants

A stem cell transplant is often the best option to
treat blood cancers, such as leukemia, lymphoma and multiple myeloma, as well as bone marrow failure
syndromes like myelodysplastic syndrome.

To understand the different types of stem cell transplants and how
they work, we spoke with Borje S. Andersson, M.D., Ph.D. Here’s what he
had to say.

What are stem cells?

Bone marrow, the spongy tissue inside our bones, is the factory for
blood cells. It creates hematopoietic stem cells that transform into
several cell types, including:

  • red blood cells, which carry oxygen to our tissues
  • platelets, which stop bleeding
  • white blood cells, which
    fight infection

Blood cancers multiply uncontrollably, hindering the growth of these
cells. A hematopoietic stem cell transplant replaces faulty cells so
the body can produce normal, healthy cells again.

What are the types of stem cell transplants?

Stem cell transplants fall into two categories: autologous and allogeneic.

An autologous stem cell transplant uses the patient’s own cells for
treatment. We extract blood cells, treat the cancer with high-dose chemotherapy, then place the cells back into the
patient. The patient has low blood counts until the replaced cells
replenish the patient’s body with healthy cells.

An allogeneic stem cell transplant is similar, but we take cells
from someone other than the patient. The transplanted cells kill any
remaining cancer cells and restore the patient’s immune system.

Where do allogeneic stem cell transplant donor cells come from?

There are three types of allogeneic stem cell transplants:

  • bone marrow transplants
  • peripheral blood
    transplants
  • cord blood transplants

With a bone marrow transplant, the donor receives general anesthesia, and the bone marrow is
extracted in a 1-2-hour procedure. Once the cancer is less active and
the patient has been pre-treated with chemotherapy (known as
conditioning), he or she receives the donor’s healthy stem cells.

With a peripheral blood cell transplant, the donor receives growth
factor shots to stimulate the bone marrow to push the stem cells into
the blood. This allows us to collect more cells in a short period,
decrease patient/donor downtime and freeze the cells for future use.

The cells for a cord blood transplant come from an umbilical cord
collected at birth by the MD Anderson Cord Blood
Bank
. For many patients who don’t have a well-matched, healthy
donor, a cord blood transplant is a viable option.

What determines if a donor is a good match?

We all have protein structures called human leukocyte antigens (HLA)
on our cells’ surfaces. We try to find a donor who has 10 antigens
that match 10 of the patient’s antigens. Since antigens are inherited,
family members, specifically siblings, are a good starting point, but
a family match isn’t guaranteed. Many patients find matched unrelated
donors through the National Marrow Donor Program.

The closer the match, the less risky the transplant. If the donor
cells aren’t a close enough match, the patient’s body may recognize
the donor cells as foreign and reject them. Or, the cells from the
donor may recognize the new body as foreign and attack. This is called
graft-versus-host disease.

If the patient can’t find a family or unrelated donor, it’s possible
to have a successful transplant with a partially matched related
donor, known as a haploidentical stem cell transplant.

How do you decide what type of stem cell transplant a patient receives?

We consider the type of disease and its progression. Most patients
with multiple myeloma or lymphoma receive autologous transplants; most
leukemia patients receive allogeneic transplants.

Other factors we consider include:

  • availability of a suitable donor
  • previous
    treatments
  • age and health of the patient and donor

Can a stem cell transplant be used in combination with other
cancer treatments?

The transplant has three phases. A week prior to the transplant, the
patient is conditioned with high-dose chemotherapy to destroy most of
the cancer and the patient’s defective immune system. Then, the
transplant repopulates the immune system with the healthy cells.

Based upon how a patient responds, the patient may receive more
treatment in a third phase. MD Anderson
has had success using post-transplant maintenance therapy with
low-dose therapy with chemotherapy and/or immune-stimulating drugs.
We’re now exploring adding engineered T-lymphocytes and/or engineered
natural killer cells to strengthen the immune system after the
transplant in patients at high risk for infection or recurrence.

Tell us about new stem cell transplant research at MD Anderson.

MD Anderson has the largest stem cell
transplant operation in the world. Our research aims to speed up
patients’ recovery and lower risk of complications.

For example, our research in the conditioning process has improved
autologous transplants for advanced Hodgkin’s disease and large cell
lymphoma. We’ve also developed a practice-changing approach for
conditioning patients with acute leukemia. In addition, we’re working
to improve and expand cord blood transplants. And we’re studying
prevention and treatment of immune-related complications, such as
graft-vs-host disease, after allogeneic stem cell transplantation.

We’re also exploring the use of cellular therapy to treat advanced
blood cancers, solid tumors, organ failure, and autoimmune and genetic diseases.

What’s your advice for potential stem cell transplant patients?

Research and learn as much as you can before seeing your doctor.
Meet with a transplant specialist, and come prepared with questions.
Consider all available options, and don’t be afraid to seek a second opinion.

Your support system is integral your success. Bring someone with you
to your consultations to take notes and process the information.
Sometimes you’ll depend solely on your caregiver.

There’s never a “right” treatment decision. So, it’s important to
work with your doctor and carefully choose the option that optimizes
your chances for a successful recovery and best fits your life.