For Patients, Families & Visitors
Return to Innovations in Care Overview
More on Innovations in Care
Hospital News
Blood and Marrow Transplantation
Innovations in Care
Novel Approaches to Transplantation
Stem Cell Transplant
(Mini or light transplant also called less intensive or non-ablative).
Traditionally, stem cell transplantation involves very high doses of chemo and/or radiation therapy to deplete the patients bone marrow. While effective, this approach may be associated with many side effects and toxicities.Our program offers a more novel approach to stem cell transplantation where, in some cases, we are able to give low dose chemotherapy combined with immune therapy in order to allow the donor cells to grow while minimizing side effects. A mini transplant may be beneficial for patients with:
- leukemias (AML, CML or JMML)
- lymphomas (Hodgkin's or non-Hodgkin's disease)
- neuroblastoma
- sickle cell disease
- thalassemia
- selected immune deficiencies
- selected metabolic disorders
- selected bone marrow failure syndromes
- selected autoimmune disorders
Umbilical Cord Blood Transplant
Our BMT program also has a highly active program in unrelated cord blood transplantation. Umbilical cord blood transplants have been used as an alternative source of stem cells since 1988 and can be an excellent source of stem cells for some patients. Only 25 percent of patients will have a matched family donor. The other 75 percent requires an alternative source of stem cells for allogeneic stem cell transplant.
Currently there are more than 100,000 frozen cord blood units available for use throughout the world. By searching various national and international cord blood registries, we are able to identify a suitable donor for almost all patients.
There are many advantages to using cord blood as a source of stem cells. For example, using umbilical cord blood stem cells reduces the risk of serious graft versus host diseasea disease where the new stem cells attack the patients own bodys cells. Cells are also readily available in cord blood banks, are routinely typed for HLA antigens (tissue typing) and blood type, and are tested for infectious agents. These frozen cord blood units can be shipped immediately for stem cell transplantation.
Unrelated Adult Donor (Non-Cord) Stem Cell Transplants
Adult donor transplants are often necessary if there is not a suitable family stem cell match or if unrelated cord blood transplant is not an option. Our program is approved by the National Marrow Donor Program to perform unrelated adult donor stem cell transplants. More than eight million potential adult donors have submitted blood samples to a number of international donor registries. We search these registries for an appropriate unrelated adult donor match. Once such a match is found, we coordinate with the registry to provide a timely stem cell collection for your child. The process of finding an unrelated adult donor can take several weeks to several months from start to finish, so this type of transplant may not be appropriate for certain conditions requiring immediate stem cell transplantation.
To ensure a safe and successful transplant, our state-of-the-art stem cell laboratory is capable of performing the following treatments when appropriate. They are non-invasive and occur prior to transplantation. The stem cell transplant team will discuss whether any of the above may be options for the patient. Stem Cell Selection prevents tumor cells from contaminating stem cells used in autologous stem cell transplants. After stem cells are collected, they are put through a machine with a special filter that selects out only the important stem cells. This process eliminates the possibility of any potential tumor cells from being infused simultaneously.
- Immune Cell Depletionlowers the risk of graft versus host disease in allogeneic stem cell transplants by removing specific immune cell populations prior to stem cell infusion.
- Red Blood Cell Depletion removes red blood cells from the stem cell product in allogeneic transplant when there is a difference in the blood type between donor and recipient.
With allogeneic transplant, cells from the donor can be used for several purposes after the transplant. White blood cells can be infused in a process known as donor lymphocyte infusion that may help accelerate the patients immune system recovery; help the transplanted stem cells to grow; and help the rest of the stem cells fight against the patients cancer. Donor white cells are particularly effective in treating leukemias, some solid tumors, post-transplant lymphomas, and various types of infection, as well as in preventing cytomegalovirus.
In addition, our program is developing protocols that involve training donor immune cells to target specific tumor proteins or infectious particles. By training these cells to react only against tumor cells, the patients normal cells ; will be less affected and the patient may experience fewer side effects and toxicity. Facilitating cells called dendritic cells are critically important indeveloping an optimal immune response against cancer cells.Other immune cells, such as natural killer cells, can also be used to treat cancer cells and do not require prior training to fight against a patients cancer.
Current studies are testing the safety and efficacy of these cells in cancer patients after stem cell transplantation. Furthermore, combining these facilitating cells (dendritic cells) with other immune white blood cells may offer additional opportunities for targeted cellular immune therapy.
With autologous transplants, we can also train immune cells. After stem cells are collected, certain immune cells are selected out using a special processing machine. Once isolated, the immune cells are put in contact with either a specific tumor cell or a specific infectious organism. After the cells are trained to react against the target cell, they are given back to the patient where they continue to react against the target cells.
Contact
- Pediatric Blood and Marrow Transplantation
-
Directions
(212) 305-8316
