Q&A

On Cancer: Stem Cell Transplant Experts Discuss the Procedure and How to Become a Stem Cell Donor

By Allyson Collins, MS, Science Writer/Editor  |  Thursday, August 30, 2012
Pictured: Adult Bone Marrow Transplantation Team Our transplantation experts work as a team to provide each patient with the best care possible.

Editor’s Note: This morning, Good Morning America co-host Robin Roberts announced that she will undergo a bone marrow transplant at Memorial Sloan Kettering Cancer Center. Learn about the treatment and recovery process from Memorial Sloan Kettering experts.

Over the course of three decades, Memorial Sloan Kettering physicians have performed more than 4,000 bone marrow transplants – nearly 400 annually in recent years. This procedure, also known as a stem cell transplant, is used to replenish bone marrow and hematopoietic stem cells that have been destroyed due to a variety of reasons, such as certain types of cancer, cancer treatments, blood diseases, or immune disorders. Hematopoietic, or blood-forming, stem cells are produced in the bone marrow.

Our investigators have also been at the forefront of research in stem cell transplantation since 1973, when our doctors performed the world's first successful transplant between a patient and an unrelated donor. Many of the transplant approaches and supportive care regimens widely used today were pioneered at Memorial Sloan Kettering.

In a recent interview, experts on our Adult Bone Marrow Transplantation Service talked about the procedure, the recovery process, and how to become a bone marrow or stem cell donor.

What does a stem cell transplant involve?

There are two main types of transplants. In an autologous transplant, a patient’s own stem cells are collected and then transplanted back. In an allogeneic transplant, the stem cells are obtained from another person or from donated umbilical cord blood and then given to the patient.

Before either type of transplant, the patient receives high doses of chemotherapy or a combination of chemotherapy and radiation therapy to kill any cancerous cells and hematopoietic stem cells in the bone marrow. Healthy blood stem cells are then transplanted into the bloodstream through an intravenous catheter, in a process similar to a blood transfusion.

The stem cells migrate to the bone marrow, where after several weeks they usually begin to develop into new infection-fighting white blood cells, oxygen-rich red blood cells, and blood-clot-forming platelets.

How do doctors decide that a person should receive a transplant?

We carefully select patients for this procedure because transplantation can be extremely challenging for a patient and his or her family. This is both because of the toxicity of the high-dose regimens before the transplant and because the patient’s immune system must be suppressed for an extended period of time after the procedure to prevent a rejection of the transplanted cells.

Despite the risks, outcomes have dramatically improved over the past decades, and stem cell transplants can often cure a person’s disease. In fact, a recent study conducted by the National Marrow Donor Program found that Memorial Sloan Kettering significantly exceeded its predicted one-year survival rate for patients undergoing an allogeneic transplant.

What is the recovery process like for a patient?

Most patients remain in the hospital for several weeks to receive medical support. To protect against infection, everyone who enters the patient’s room is required to wear gloves, masks, and sometimes disposable gowns, and to wash their hands with antiseptic soap. Patients can’t have any fresh fruit, flowers, or plants in their rooms, as these can carry disease-causing molds and bacteria.

The first year after the transplant is critically important because it’s the period when complications – such as infection or rejection – are most likely to happen. Patients are typically able to get back to their regular activities after a year, with a lower risk of developing an infection.

How do you identify donors for patients who need an allogeneic transplant?

Finding an appropriate donor is critical to the success of an allogeneic transplant. Because the immune system can identify and destroy any cells perceived as foreign, a donor’s tissue type should match the patient’s as closely as possible. The process of tissue typing is based on analyzing proteins called human leukocyte antigens (HLA), which are found on the surface of white blood cells and tissues.

We work closely with our patients to find a bone marrow match. Often, the ideal donor is a sibling who has inherited the same HLA. The majority of patients do not have a brother or sister who is a match, so we can look for other family members who may be a partial match. But because family size is getting smaller in North America, it is becoming more challenging to find appropriate family member donors.

We often look to volunteer donor registries, such as the National Marrow Donor Program, and in some cases we consider using umbilical cord blood stored in public banks, such as through National Cord Blood Program. It can also be difficult to find stem cells from people of mixed ethnic or minority backgrounds through these registries, so we encourage more people to consider becoming a donor.

How can I register to become a bone marrow or stem cell donor?

You can join the Be The Match Registry or DKMS Americas. Everyone who is medically able should consider becoming part of a marrow registry. Learn more about who can donate, donor requirements, and medical guidelines from the National Marrow Donor Program.

Comments

I am VYN Sarma writing this mail from Hyderabad, India. I felt extremely to go through the above subject on stem cell transplantation. My grandson who is 6 years old is a thalassemia major patient. He is not having any siblings. Is there any opportunity that stem cell transplant surgery can be done to my grandson from unrelated donor at your esteemed organization.

Thank you for your comment! If you would like to make an appointment with a Memorial Sloan-Kettering physician, please review our information for international patients: http://www.mskcc.org/cancer-care/international-patients.

My wife was diagnosed with Myelodysplasia and she elected to have blood transfusions as her treatment after the EPO injections ceased to be effective . She died from ferritin overload causing heart failure 5 and a half years after diagnosis . Would marrow transplant have been a suitable treatment ?

We are sorry for your loss. Unfortunately, we cannot comment on specific medical cases through our blog.

I had a bone marrow stem cell transplant at MSKCC in 2006. My donor was unrelated and mismatched. I was 68 at the time. I am remarkably healthy and have been leukemia free for 6 1/2 years. Thanks to MSKCC & my donor.

I want to take a swab test to see if I am a donor for a specific person but I do not want to be on a national registry. How do I go about getting the kit or taking the test?

In order to take a swab test on your own, you would have to become part of a registry. You can learn more at http://marrow.org.

Thank you. I actually found a lab where I can buy the test and have them give me the results without having to be in the registry.

My daugther is pregnant and thinking of possibly banking the baby's cord blood. She has read much research on this issue but is still unsure what is the best choice. Is wiser to donate the cord blood or pay to have banked it at a private facility. She read that it can be used to treat up to 80 diseases however, if they are genetic her child would not be able to use his own cord blood. Can you provide some input on this issue. thank you

Nancy, we are not able to provide personal medical advice on our blog. However, if you are interested in learning more about cord blood, you might want to visit the National Cord Blood Program website at http://www.nationalcordbloodprogram.org/. Thank you for your comment, and congratulations on your new grandchild!

My father was diagnosed w MDS in January we have been traveling to MSK from CT for dr visits and chemo. A stem cell transplant is next I have been praying everyday. My dad is 61 and full of life. The staff at MSK is great it's good to be treated by the best. I just wanted to sign on here and see others stories it helps me feel a little better. God bless you all

Dear Joe, sorry to hear about your father.

Here is a link to a story on our web site about a patient who was diagnosed with MDS and had a bone marrow transplant -- it's definitely worth a read: http://www.mskcc.org/cancer-care/patient-stories/nancie

Also, you may be interested in contacting our Patient to Patient Support Program, which can put him in touch with another patient who has been through a similar experience and completed treatment. They can be reached at 212-639-5980 -- here is a link with more information, FYI: http://www.mskcc.org/cancer-care/counseling-support/patient-patient-support

Another good source of support is our online community, called MSKCC Connections, where patients, family members, friends, and caregivers can share information, support, and inspiration. Here is a link with more information and how to join: http://www.mskcc.org/cancer-care/counseling-support/connections-online-community

We hope this information is useful and wish you father all the best as he moves forward with treatment.

My husband was recently diagnosed with MDS with the presence of Inv(3). Is there any arbitrary age limit to receive a transplant or is a case by case assessment made regardless of age? Thank you.

Lynn, there is no age limit to receiving a bone marrow transplant. The decision about whether a particular patient is eligible is based on an assessment of the person's overall health. If your husband would like to speak with a doctor at Memorial Sloan-Kettering, one of you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment to learn more about making an appointment. Thank you for your comment.

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