Stem cell transplants are used to return stem cells when the bone marrow has been destroyed by disease, chemotherapy (chemotherapy) or radiation. Depending on where the stem cells come from, the transplant procedure can be described as follows:
- Bone marrow transplant (BMT)
- Peripheral blood stem cell transplantation
- umbilical cord blood transplant
All of them can be referred to as hematopoietic stem cell transplants.
A typical stem cell transplant for cancer uses very large doses ofchemotherapyare used, sometimes together withradiotherapy, to try to kill all the cancer cells. This treatment also kills stem cells in the bone marrow. this is calledmyeloablationormyeloablative therapy. Soon after treatment, stem cells are given (transplanted) to replace those that have been destroyed. The replacement stem cells are given into a vein, similar to a blood transfusion. The goal is for the transplanted cells to settle in the bone marrow over time, begin to grow and form healthy blood cells. This process is calledimplantation.
There are 2 main types of transplants. They are named after the stem cell donor.
- Autolog:car meansauto. The stem cells in autologous transplants come from the same person who receives the transplant, so the patient is his or her own donor.
- Halogen:halo meansOthers. The stem cells in allografts come from someone other than the patient, whether a matched donor or not.
Autologous stem cell transplant
In this type of transplant, the first step is to remove orharvesttheir own stem cells. Your stem cells are taken from your bone marrow or blood and then frozen. (You can learn more about this process atWhat is it like to donate stem cells?) After you receive high doses of chemotherapy and/or radiation as part of your myeloablative therapy, the stem cells are thawed and returned to you.
Benefits of autologous stem cell transplantation:One benefit of autologous stem cell transplantation is that you get your own cells back. If you take With your own stem cells back, you don't have to worry about them (called transplanted or "engrafted" cells) being rejected by your body.
scratchs of autologous stem cell transplantation:Transplants can still fail, which means that the transplanted stem cells will not reach the bone marrow and produce blood cells as they should. Furthermore, autologous transplants cannot produce the "graft versus cancer" effect. A potential downside of an autologous transplant is that cancer cells can be collected along with the stem cells and later reintroduced into your body. Another disadvantage is that your immune system is the same as before the transplant. This means that the cancer cells were able to escape an attack by your immune system and may be able to do so again.
This type of transplant is mainly used to treat certain medical conditions.leukemias,lymphoma, Emultiple myeloma. It is sometimes used for other types of cancer, such astesticular cancerENeuroblastomaand certain types of cancer in children. Doctors may also use autografts for other diseases, such as systemic sclerosis, multiple sclerosis (MS), and systemic lupus erythematosus (lupus).
Elimination of cancer cells in stem cells saved for autologous transplants
To prevent the remaining cancer cells from being transplanted along with the stem cells, some centers treat the stem cells before returning them to the patient. This can be calledLavar. While this may work for some patients, there haven't been enough studies yet to know if this is actually a benefit. A possible downside to purification is that some normal stem cells may be lost during this process. This can mean that your body takes longer to start producing normal blood cells and you may have very low and unsafe levels of white blood cells or platelets for an extended period of time. This can increase the riskinfectionsor bleeding problems.
Another treatment to kill cancer cells that may be in the returned stem cells is to administer anti-cancer drugs after the transplant. Stem cells are not treated. After the transplant, the patient is given anticancer drugs to get rid of any cancer cells that may be in the body. this is calledliveLavar. For example lenalidomide (Revlimid®) can be used in this way in multiple myeloma. The need to remove cancer cells from transplanted stem cells or from transplant patients, and how best to do this, remains to be explored.
Tandem transplants (double autologous)
Performing 2 autologous transplants in a row is calledTandemtransplantationor onedouble autologous transplant.In this type of transplant, the patient receives 2 high-dose chemocycles as myeloablative therapy, each followed by a transplant of their own stem cells. All the necessary stem cells are collected before the first high-dose chemotherapy treatment and half are used for each transplant. Typically, the 2 cycles of chemotherapy are given within 6 months. The second is given after the patient has recovered from the first.
Tandem transplants have become the standard of care for certain types of cancer. High-risk types of childhood neuroblastoma and multiple myeloma in adults are cancers for which tandem transplants seem to show good results. But doctors don't always agree that these are actually better than a single transplant for certain types of cancer. As this treatment includes 2 transplants, the risk of serious consequences is greater than with a single transplant.
An autologous transplant followed by an allogeneic transplant is sometimes called a tandem transplant. (See minitransplants below.)
Allogeneic stem cell transplantation
Allogeneic stem cell transplants use stem cells from donors. In the most common type of allogeneic transplant, the stem cells come from a donor whose tissue type is very similar to yours. (This is discussed in Matching Patients and Donors.) The best donor is a close family member, usually a brother or sister. If you don't have a good family match, a public donor can be found through a national registry. This is sometimes calledDIRT(matched unrelated donor)Transplantation. Transplants with a MUD are generally more risky than those with a matched relative.
An allogeneic transplant works in the same way as an autologous transplant. Stem cells are collected from the donor and stored or frozen. After receiving high doses of chemotherapy and/or radiation as myeloablative therapy, the donor stem cells are thawed and given to you.
Blood taken from the placenta and umbilical cord of newborns is a type of allograft. This small volume ofCabobloodit has a high number of stem cells that tend to multiply quickly. Cord blood transplants are performed for both adults and children. As of 2017, approximately 700,000 units (batches) of cord blood have been donated for public use. And even more were collected for private use. In some studies, the risk of a cancer not going away or coming back after a cord blood transplant was lower than after a transplant from an unrelated donor.
Benefits of allogeneic stem cell transplantation:Donor stem cells make their own immune cells that can help kill any cancer cells that remain after high-dose treatment. This is calledGraft versus CancerorGraft versus Tumor It is made. Other benefits include that the donor can often be asked to donate more stem cells or even white blood cells if needed, and stem cells from healthy donors are cancer free.
scratchs of allogeneic stem cell transplantation: Transplantation or transplantation may not take place - which means that the transplanted donor stem cells may die or be destroyed by the patient's body before settling in the bone marrow. Another risk is that the donor's immune cells will not only attack the cancer cells, but also the healthy cells in the patient's body. this is calledGraft versus host disease. There is also a very low risk of certain infections from the donor's cells, although donors are tested before donating. You are more at risk for infections that you once had that your immune system was keeping in check. These infections can occur after an allogeneic transplant because your immune system is kept in check (suppressed) by drugs called drugsimmunosuppressant drugs. Such infections can cause serious problems and even death.
An allogeneic transplant is most commonly used to treat certain types ofleukemia,lymphoma,multiple myeloma,myelodysplasty syndromeand other bone marrow diseases such as aplastic anemia.
Mini-Transplantes (transplantes non-mieloablativos)
For some people, due to age or certain medical conditions, it is riskier to have myeloablative therapy, which obliterates all of the bone marrow before a transplant. For these people, doctors may use a type of allograft, sometimes called a mini-graft. Your doctor may refer to it as anon-myeloablative transplantor mentionReduced Intensity Conditioning (RIC). Patients who receive a mini-graft generally receive lower doses of chemotherapy and/or radiation than standard myeloablative transplantation. The purpose of the mini-transplant is to kill some of the cancer cells (which will also kill some of the bone marrow) and to suppress the immune system just enough for the donor stem cells to colonize the bone marrow.
Unlike the usual allogeneic transplant, after a mini-transplant, the donor and patient's cells coexist in the patient's body for some time. But slowly, over months, the donor cells take over the bone marrow and replace the patient's own bone marrow cells. These new cells can then mount an immune response against the cancer and help kill the patient's cancer cells - the graft-versus-cancer effect.
An advantage of a mini-transplant is that it requires lower doses of chemotherapy and/or radiation. And because not all stem cells are killed, the blood cell count doesn't drop as much while you wait for the new stem cells to start forming normal blood cells. This makes it especially useful for elderly patients and people with other health conditions. Rarely, it can be used in patients who have already had a transplant.
Mini-grafts treat some conditions better than others. They may not work well for patients with a lot of cancer in their bodies or people with fast-growing cancers. Although chemotherapy and radiation have fewer side effects than standard allogeneic transplantation, the risk of graft-versus-host disease is the same. Some studies have shown that, for some types of cancer and other blood disorders, adults and children can get the same results with a mini-transplant as with a standard transplant.
Syngeneic stem cell transplants (for identical siblings)
This is a special type of allograft that can only be used if the patient has an identical sibling (twins or triplets) - someone who has the exact same type of tissue. An advantage of syngeneic stem cell transplantation is that graft-versus-host disease is not a problem. Furthermore, there are no cancer cells in the transplanted stem cells, as could be the case with an autologous transplant.
One disadvantage is that there is no graft versus cancer effect because the new immune system is very similar to the recipient's immune system. Every effort must be made to destroy all cancer cells before the transplant is done to prevent the cancer from returning.
Improvements were made to use family members as donors. This type of transplant is called Ahalf-match (haploidêntico) transplant for those who do not have a fully compatible or identical family member. This may be another option to consider along with cord blood transplantation and matched unrelated donor (MUD) transplantation.
The importance of patient-donor compatibility
Whenever possible, it is very important that the donor and recipient avoid a close tissue match. transplant rejection.Transplant rejection occurs when the recipient's immune system recognizes the donor's cells as foreign and tries to destroy them like bacteria or viruses. Transplant rejection can lead to transplant failure, but it is rare when the donor and recipient are a match.
A more common problem is that when donated stem cells create their own immune cells, the new cells can mistake the patient's cells for foreign and attack their new "home." this is calledGraft versus host disease. (VerStem cell transplant side effectsmore about that). The new transplanted stem cells attack the body of the person who received the transplant. This is another reason why finding the closest possible match is so important.
What makes a stem cell donor compatible? What does it mean to be an HLA Match?
Many factors play a role in how the immune system recognizes the difference between self and non-self, but most important for transplants is theHuman Leukocyte Antigen (HLA)System. Human leukocyte antigens are proteins found on the surface of most cells. They form a person's tissue group, which is distinct from a person's blood group.
Each person has a set of HLA antigen pairs. We inherit it from our parents and, in turn, we pass it on to our children. Doctors try to match these antigens when they find a donor for a person who is going to have a stem cell transplant.
Matching the donor and recipient HLA tissue types plays an important role in the functioning of the transplant. A match is best when all 6 major known HLA antigens are the same - a 6 out of 6 match. People with these matches have a lower risk of graft-versus-host disease, transplant rejection, weak immune systems and serious infections . Bone marrow and peripheral blood stem cell transplants sometimes use a donor with a single mismatched antigen - a 5 out of 6 match. In cord blood transplants, a perfect HLA match does not seem to matter much, and even a sample with some incompatible antigens may be ok.
Doctors are learning more and more about the best ways to match donors. Today, siblings may need fewer tests because their cells vary less than an unrelated donor. However, to reduce the risk of type mismatches between unrelated donors, more than the 6 basic HLA antigens can be tested. For example, doctors sometimes try to get a 10 out of 10 match. Certain transplant centers now require high-resolution matching, which drills down into tissue types and allows for more specific HLA matching.
find a match
There are thousands of different combinations of possible HLA tissue types. This can make finding an exact match difficult. HLA antigens are inherited from both parents. When possible, the search for a donor usually begins with the patient's siblings (siblings) who have the same parents as the patient. There is a 1 in 4 chance that one of the siblings will be a perfect match (that is, you both received the same set of HLA antigens as your parents).
If a sibling is not a good match, the search may shift to relatives less likely to be a match - parents, half-siblings, and relatives such as aunts, uncles, or cousins. (Spouses are no more likely to be a good match than other people who are not related.) If no close relatives are found, the transplant team expands the search to the general public.
As unlikely as it sounds, it is possible to find a good match with a stranger. To assist in this process, the team will use transplant registries such as those listed here. The registries serve as matchmakers between patients and voluntary donors. You can search and access millions of potential donors and hundreds of thousands of cord blood units.
be the game (sooner orNational Bone Marrow Donor Program)
Toll Free Number: 1-800-MARROW-2 (1-800-627-7692)
Blood and Bone Marrow Transplant Information Network
Toll free number: 1-888-597-7674
Various other international registries are also available, depending on an individual's tissue type. Sometimes the best matches are found among people of similar racial or ethnic background. Compared to other ethnic groups, whites are more likely to find a perfect match for a stem cell transplant from unrelated donors. This is because ethnic groups have different HLA types and historically there has been less diversity in donor registries or fewer non-white donors. However, the chances of finding a matching donor increase each year as more volunteers find out and apply to the registries.
Finding an unrelated donor can take months, although cord blood can go a little faster. A single game can require searching millions of records. As transplant centers use high-resolution tests more frequently, matching becomes more complex. 10 out of 10 perfect matches in this level are much harder to find. But transplant teams are also getting better at figuring out which types of mismatches can be tolerated in which situations—that is, which mismatched antigens are least likely to affect transplant success and survival.
Keep in mind that this process has steps - there could be multiple matches that look promising but don't work out as expected. The team and registry will continue to look for the best possible match for you. If your team finds an adult donor through a transplant registry, the registry will contact the donor to determine final testing and donation. If your team finds matching cord blood, the registry will send the cord blood to the transplant center.
What type of stem cells are used in bone marrow transplants? ›
Hematopoietic stem cells are stem cells that turn into blood cells. Bone marrow is soft, spongy tissue in the body that contains hematopoietic stem cells. It is found in the center of most bones. Hematopoietic stem cells are also found in the blood that is moving throughout your body.What are the 4 types of stem cell therapy? ›
ASCs: Types and Use in Cell Therapy
ASCs include hematopoietic stem cells (HSCs), skin stem cells (SSCs), neural stem cells (NSCs), and mesenchymal stem cells (MSCs) (62).
A stem cell transplant uses stem cells from your bloodstream, or a donor's bloodstream. This is also called a peripheral blood stem cell transplant. A bone marrow transplant uses stem cells from your bone marrow, or a donor's bone marrow. Stem cell transplants are the most common type of transplant.What is the most common stem cell transplant? ›
Allogeneic Stem Cell Transplantation
This is the most common type of stem cell transplantation used to treat AML. Allogeneic transplantation uses healthy blood-forming cells from an HLA-matched family member, an unrelated donor, or from umbilical cord blood.
They serve as a repair system for the body. There are two main types of stem cells: embryonic stem cells and adult stem cells.What is the best type of stem cell therapy? ›
The best-defined and most extensively used stem cell treatment is hematopoietic (or blood) stem cell transplantation, for example, bone marrow transplantation, to treat certain blood and immune system disorders or to rebuild the blood system after treatments for some kinds of cancer.What are the 5 different types of stem cells? ›
- Hematopoietic Stem Cells (Blood Stem Cells)
- Mesenchymal Stem Cells.
- Neural Stem Cells.
- Epithelial Stem Cells.
- Skin Stem Cells.
Autologous stem-cell transplantation (ASCT) is part of standard therapy for lymphoma. Although ASCT appears to improve survival in several lymphomas [1,2,3,4,5,6,7], it is associated with a significant treatment-related mortality (TRM; 2.5% to 11%) [6, 8,9,10].What are the two types of stem cell transplants? ›
- Autologous transplantation uses the patient's own stem cells. These cells are removed, treated and returned to his or her own body after a conditioning regimen.
- Allogeneic transplantation uses stem cells from a donor. A donor may be a family member or someone who is not related to the patient.
Autologous transplants have a lower risk of life-threatening complications; there is no risk of GVHD and no need for immunosuppressive therapy to prevent GVHD and graft rejection. Immune reconstitution is more rapid than after an allogeneic transplant and there is a lower risk of opportunistic infections.
What are the disadvantages of autologous stem cell transplant? ›
The disadvantages of autologous BMT include the likelihood of tumor cell contamination within the graft in many diseases, which can contribute to relapse; the lack of a significant therapeutic graft-versus-tumor effect; and the limited ability to use autologous stem cells to treat patients not in remission or with ...How many stem cells are needed for a bone marrow transplant? ›
What are the steps in an autologous stem cell transplant? Collecting the stem cells: Before treatment begins, a needle is inserted into the patient's arm vein. Blood is withdrawn and redirected into a special machine that removes about 4 million stem cells – the amount needed for a transplant.Where do stem cells come from for bone marrow transplant? ›
Depending on the type of transplant that's being done, there are 3 possible sources of stem cells to use for transplants: Bone marrow (from you or someone else) The bloodstream (peripheral blood – from you or someone else) Umbilical cord blood from newborns.Who Cannot donate stem cells? ›
Most diseases which may be defined as autoimmune disorders, such as multiple sclerosis, systemic lupus, chronic fatigue syndrome and fibromyalgia, will prevent you from donating marrow or blood-forming cells.
Donating stem cells or bone marrow to a relative
A brother or sister is most likely to be a match. There is a 1 in 4 chance of your cells matching. This is called a matched related donor (MRD) transplant. Anyone else in the family is unlikely to match.
The cost of a stem cell transplant can vary depending on the type of treatment needed, ranging from $15,000 to $75,000. According to a 2022 poll, treatments cost between $10,000 and $40,000, while a Twitter poll reported that patients could expect to spend from under $5,000 to over $50,000.What is a perfect match for bone marrow transplant? ›
The best marrow transplant outcomes happen when a patient's human leukocyte antigen (HLA) and the HLA of a registry member or cord blood unit closely match. This is much more complex than matching blood types. HLA is a protein – or marker – found on most cells in your body.What type of stem cell is most important? ›
Embryonic stem cells are pluripotent, meaning they can give rise to every cell type in the fully formed body, but not the placenta and umbilical cord. These cells are incredibly valuable because they provide a renewable resource for studying normal development and disease, and for testing drugs and other therapies.What is the success rate of stem cell therapy? ›
Here is information on three-year survival rates: Multiple myeloma: Data show 79% were alive three years after transplant. Hodgkin lymphoma: Studies show most people receive HSCT to treat Hodgkin lymphoma that came back after chemotherapy. Of those, 92% of those people were alive three years after the transplant.What are the disadvantages of stem cell therapy? ›
- Low blood cell counts. You will have low blood cells counts after a stem cell transplant. ...
- Infection. ...
- Bleeding. ...
- Anemia. ...
- Graft-versus-host disease (GVHD) ...
- Veno-occlusive disease (VOD) ...
- Digestive system problems. ...
- Skin and hair problems.
What is the best stem cell clinic in the US? ›
Mayo Clinic is among the best stem cell transplant hospitals in the world. They have been performing stem cell transplants since 1963, making them one of the world's oldest stem cell therapy providers. They are the leaders in the innovation of stem cell transplants.Where is the best place in the world for stem cell therapy? ›
Founded by Dr. Neil Riordan, a globally recognized stem cell expert and visionary, the Stem Cell Institute in Panama is among the world's leaders in stem cell research and therapy.Why do people go to Mexico for stem cell therapy? ›
Wondering why to choose Mexico for stem cell transplant, here are the reasons: Location: It is a popular destination for medical travel. The source markets including America, Canada, and Europe. Cost-Effective: Stem cell therapy cost in Mexico is lower than the prices in the USA and Canada.What are the main types of stem cells? ›
Stem cells are divided into 2 main forms. They are embryonic stem cells and adult stem cells.How many types of stem cells are present in bone marrow? ›
The bone marrow is constituted of two separate and distinct stem cells. The hematopoietic stem cells (HSC) are responsible for the production and maintenance of all the mature blood cells. The mesenchymal stem cells constituted the bone marrow stroma.What causes death after stem cell transplant? ›
Besides the risk of relapse, hematopoietic stem cell transplantation (HSCT) remains associated with significant early and late treatment related mortality (TRM). Infections, toxicity, and (after allogeneic HSCT only), graft-vs. -host disease (GVHD) are the main causes of death.How long do you stay in hospital after autologous stem cell transplant? ›
Many people are well enough to leave hospital between 1 and 3 months after the transplant. However, if you develop complications such as an infection, you may have to stay in hospital for longer.Who is candidate for autologous stem cell transplant? ›
Autologous stem cell transplants are typically used in people who need to undergo high doses of chemotherapy and radiation to cure their diseases. These treatments are likely to damage the bone marrow. An autologous stem cell transplant helps to replace the damaged bone marrow.What are stem cell transplant techniques? ›
To prepare for a stem cell transplant, you receive chemotherapy to kill the diseased cells and malfunctioning bone marrow. Then, transplanted blood stem cells are put into your bloodstream. The transplanted stem cells find their way to your marrow, where — ideally — they begin producing new, healthy blood cells.Why do autologous stem cell transplants fail? ›
Graft failure is extremely unusual in autologous stem cell transplantation. Graft failure occurs when bone marrow function does not return. The graft may fail to grow in the patient—resulting in bone marrow failure—with the absence of red blood cells, white blood cells and platelet production.
Is autologous stem cell transplant covered by insurance? ›
“Are stem cell therapies covered by insurance?” The short answer is no, but there are instances where there may be some kind of coverage.What happens if autologous stem cell transplant fails? ›
Doctors may be able to use a different cord blood unit or an adult donor instead. Other treatment options may include clinical trials, treatment with white blood cells from your donor (donor lymphocyte infusion), and supportive care.Can your body reject a stem cell transplant? ›
The body's immune system can attack the donor stem cells. This is called rejection. The transplanted cells can attack the body's cells. This is called graft-versus-host disease.Why do people not like the use of stem cells? ›
Opponents argue that the research is unethical, because deriving the stem cells destroys the blastocyst, an unimplanted human embryo at the sixth to eighth day of development. As Bush declared when he vetoed last year's stem cell bill, the federal government should not support “the taking of innocent human life.”How long are you immunocompromised after an autologous stem cell transplant? ›
It usually takes 3 to 12 months for your immune system to recover from your transplant. The first year after transplant is like your first year of life as a newborn baby. During this time, you're at risk for infection. Your transplant team will check your blood cell counts to see how well your immune system is working.What is the best type of stem cell? ›
Totipotent stem cells are able to divide and differentiate into cells of the whole organism. Totipotency has the highest differentiation potential and allows cells to form both embryo and extra-embryonic structures. One example of a totipotent cell is a zygote, which is formed after a sperm fertilizes an egg.What are the 5 types of stem cells? ›
- Hematopoietic Stem Cells (Blood Stem Cells)
- Mesenchymal Stem Cells.
- Neural Stem Cells.
- Epithelial Stem Cells.
- Skin Stem Cells.
The best-defined and most extensively used stem cell treatment is hematopoietic (or blood) stem cell transplantation, for example, bone marrow transplantation, to treat certain blood and immune system disorders or to rebuild the blood system after treatments for some kinds of cancer.What not to do after stem cell treatment? ›
Avoid impact activities such as running, tennis, zumba, hiking, etc. Week 2-6: Avoid impact activities such as running, tennis, zumba, hiking, etc. for the first 6 weeks. Light to moderate walking and low impact activities like bike riding or elliptical are good during this time period.What are the cons of stem cell therapy? ›
Cons of the stem cell therapy include: Adult stem cells are hard to grow for long period in culture. There is still no technology available to generate adult stem cells in large quantities. Stimulated pluripotent cells normally do not have any p method of maintenance and reproducibility.
Where is the best source of stem cells? ›
The Best Sources Of Stem Cells Explained: Cord Blood, Bone Marrow, and Teeth.What are the differences between stem cell types? ›
Pluripotent cells can give rise to all of the cell types that make up the body; embryonic stem cells are considered pluripotent. Multipotent cells can develop into more than one cell type, but are more limited than pluripotent cells; adult stem cells and cord blood stem cells are considered multipotent.