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(203) 688-4242
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(203) 688-4177
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(203) 688-2222
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(203) 688-3333
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(203) 688-2221
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(203) 688-3331
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(203) 688-9907
Mailing address:
Yale-New Haven Hospital
20 York Street
New Haven, CT
06510-3202
Bone marrow and stem cell transplantation program
Patients who need bone marrow or stem cell transplantation at Yale-New Haven should know they are receiving the transplant at one of the country's leading transplant centers.
What is bone marrow?
Bone marrow is spongy material found inside bones that produces white
and red blood cells and platelets. Marrow contains the stem cells that
can reproduce all the types of blood cells.
Why are bone marrow and stem cell transplants used?
Bone marrow and/or stem cells are collected in preparation for a patient
to undergo high-dose chemotherapy. High-dose chemotherapy destroys cancer
cells, but also kills most of the bone marrow and stem cells, leaving
the patient vulnerable to infection and bleeding. Giving the patient back
the stem cells enables the body to regenerate its ability to make blood
cells including cells of the immune system that are necessary to fight
off disease. Up until recently, aggressive chemotherapy and stem cell
transplants were used when other treatments had failed. By that time,
patients were in fragile health and their tumors had developed resistance
against chemotherapy. But now, physicians have begun using high-dose chemotherapy
as a first step in therapy because chemotherapy is most effective against
cancers in patients who haven't been exposed to a lot of treatment. Therefore,
stem cell or bone marrow transplants are now being used more frequently
and earlier in cancer treatment than in prior years.
What are stem cells?
Stem cells are rare cells found in bone marrow. They are the building
blocks of the three types of blood. They are amazing because they are
able to mature into red blood cells, white blood cells and platelets,
which help blood clot. Yet a constant supply of stem cells remains in
bone marrow. Without bone marrow stem cells, a person would not be able
to fight off infection, (the job of white blood cells), stop bleeding
(the job of platelets), or bring oxygen to the cells of the body (the
job of red blood cells).
There are also small numbers of stem cells found in the blood. Peripheral blood stem cell transplantation involves the removal of some stem cells from the circulating blood by a machine in a procedure known as apheresis. These cells are given back to the patient after treatment (stem cell transplant).
What cancers are treated with bone marrow
or stem cell transplants?
Transplants are currently being used primarily to treat Hodgkin's and
non-Hodgkin's lymphoma, leukemia and some breast cancers. They may also
prove effective with certain lung and ovarian cancers.
What are the types of transplants?
Four types of bone marrow transplants are used to treat cancer patients:
- autologous (the patient's own marrow or stem cells);
- syngeneic (from an identical twin);
- matched allogeneic (from a family member or unrelated (genetically-similar individual) with the same tissue or HLA type; and
- partially mismatched allogeneic transplant from a family member with only a partial matching of HLA typing, which is the so-called haplo-identical donor.
What is the difference between bone marrow
and stem cell transplants?
Stem cell transplantation usually refers to cases of
transplantation in which the stem cells are collected from the peripheral
blood by apheresis. When stem cells are collected by harvesting them from
the bone marrow, it is called bone marrow transplantation. Collecting
stem cells from the blood stream is less inconvenient for the donor than
harvesting stem cells from bone marrow, which requires hospitalization
and general anesthesia. Stem cell collection is done on an outpatient
basis.
Is there any special preparation required for a stem cell transplant?
There are only small numbers of stem cells normally found in bone marrow.
In fact, although human marrow contains about 10 billion cells at any
one time, only about 100,000 of them are stem cells. It had been shown
that it is possible to increase the numbers of stem cells in the bloodstream
by treating the patient with a mobilizing dose of chemotherapy or by giving
factors that stimulate stem cells. Those two discoveries have made it
possible to harvest stem cells on an outpatient basis and this is done
in the Yale-New Haven Apheresis and Transplantation Center.
What is involved in bone marrow collection?
Bone marrow collection requires a patient to go to the operating room,
receive general anesthesia and have bone marrow with withdrawn from the
hip bone with a needle. In contrast, most patients donating stem cells
come to the Apheresis and Transplantation Center for three to four hours
on three consecutive days to have stem cells harvested. While blood is
separated into components by the apheresis machine, patients read, watch
television and talk with each other. Afterward, they can go home.
What happens after the marrow or stem cells are collected?
If a patient is donating his own stem cells, the collected cells are measured,
processed and frozen in liquid nitrogen until he has undergone high-dose
chemotherapy. Forty-eight to 72 hours after the body has rid itself of
the chemotherapy, patients receive back their own stem cells that go to
the bone marrow and start to produce blood cells to replace those damaged
by the high dose chemotherapy.
How long is the recovery time?
Autologous stem cell transplant patients often recover at home with the
support of home health care. They are admitted to the hospital only if
they show signs of infection. In contrast, bone marrow transplant patients
spend as much as a month in the hospital in "clean rooms" designed to
reduce the possibility of infection.
How long have stem cell transplants been done at Yale-New Haven?
The first patients had stem cell transplants at Yale-New Haven Hospital
in 1993. This year about 150 patients will receive transplants of their
own stem cells and nearly 20 will receive compatible stem cells from other
donors.
Must patient and donor tissue blood types always match exactly?
No. A new form of bone marrow and stem cell transplantation between related
donors is now available and offers lifesaving transplant opportunities
to many more patients than traditional allogeneic transplants among from
related or unrelated donors. The technique known as Haplotype Mismatch
Transplants allows transplants between parents, siblings or children even
though they may be only half matched.
The Allogeneic Bone Marrow and Stem Cell Transplantation program at the Yale Cancer Center was one of the first cancer centers to use the procedure. Only 30 percent of all patients have a perfect match from an immediate relative. Most of the remaining 70 percent wait months to find a matched donor and some never do. The new transplant offers additional treatment options to patients who previously had no other option. Bone marrow or stem cell transplants from unrelated people whose marrow does not match yours exactly still carry the serious risk of rejection and other complications.
How do I know if I'm a good candidate for bone marrow or stem cell transplantation?
Discuss your options for treatment with your physician. This method has
given good results in many people - comparable to other types of treatment
- but is often very expensive, may not be covered by insurance, is complicated
with potential risks and the bone marrow transplant involves a long hospital
stay.
Related links
Cancer Services home page
Online physician referral service
Last revised: April 27, 2007 (dh)
