Since the OSUCCC – James began its Blood and Marrow Transplant (BMT) Program more than 40 years ago, many advancements have been made not only in improving BMT care but also expanding the types of transplants we offer.
Blood and marrow transplants used to be performed using only a sibling donor or a perfect match from an unrelated donor. Our BMT experts now have many transplant options, allowing us to better tailor the treatment to your unique blood cancer or blood disorder. As the largest adult BMT program in Ohio, we offer types of transplants not always available elsewhere.
What type of blood or marrow transplant you’re a candidate for will depend on a variety of factors, so let our BMT experts guide you to the treatment option that will give you the best potential outcome.
Types of blood and marrow transplants
It’s important to remember that not every person with a blood cancer or blood disorder will be eligible for every type of blood or marrow transplant. Your doctor will consider what condition you have, the stage, your overall health, your living situation and availability of a donor when recommending a BMT treatment plan.
Typically, blood and marrow transplants use stem cells from one of three different locations: bloodstream, bone marrow or umbilical cord.
These stem cells either come from a donor, which is called an allogeneic transplant, or your own body, which is called an autologous transplant. The OSUCCC – James is home to doctors who specialize in either allogeneic or autologous transplants, making them true experts in their field.
Types of allogeneic transplants
Allogeneic blood or marrow transplants are procedures that use stem cells collected from a donor. There are several different types of donor BMT treatments performed at the OSUCCC – James: peripheral blood stem cell transplant, bone marrow transplant and cord blood transplant.
Peripheral blood stem cell transplant
In this procedure, a person receives healthy blood-forming cells called peripheral blood stem cells from a donor. These cells come from the bloodstream.
Before collecting peripheral blood stem cells from a donor, daily injections are given for five days to stimulate stem cells in the bone marrow to move to the peripheral blood. The stem cells are collected through an IV in their arm or through a flexible tube called a central venous catheter that’s placed in a large vein in the neck, chest or groin area. The blood goes through a machine that removes the stem cells, and then, the blood is returned to the donor in a continuous loop. Finally, the stem cells are processed in a laboratory and administered to the recipient.
Bone marrow transplant
In this procedure, a person receives healthy bone marrow from a donor. Bone marrow is the soft, spongy material found in bones, and it’s responsible for blood cell production and immune system function.
Bone marrow donation involves a short procedure during which the donor is under general anesthesia and bone marrow is removed. Then, the marrow is processed in a laboratory and given to the recipient as an infusion.
Cord blood transplant
Stem cells are also found in umbilical cord blood. When a baby is born, parents can choose to have their baby’s cord blood stored or donated to a cord blood bank, which can help people find a transplant match.
However, cord blood transplants are rarely used since the volume of stem cells found in cord blood units is small, typically requiring more than one unit. Also, this type of transplant can be complicated by recurrent infections.
Autologous transplant
Autologous stem cell transplants use your body’s own stem cells to restore blood-making cells destroyed by chemotherapy or radiation.
Before treatment with chemotherapy and radiation, we remove healthy stem cells and safely store them until you need them. Then, we infuse them back into your body after treatment.
Autologous transplant has the benefit of your body not rejecting the stem cells or attacking healthy cells (graft-versus-host disease). A drawback is that the transplanted stem cells can’t attack any leftover cancer cells. Also, autologous transplants aren’t available for all blood cancers.
Myeloablative BMT versus reduced-intensity BMT
The BMT process begins with chemotherapy, and sometimes radiation is also added to your treatment regimen. This kills cancer cells but also weakens your immune system and damages blood-making cells. The transplant of healthy cells can restore what is destroyed.
Myeloablative transplants
A myeloablative blood or marrow transplant uses high doses of chemotherapy and radiation before the transplant. This is associated with higher toxicity, so it is used for transplants in the youngest and fittest people eligible for the treatment.
Reduced-intensity transplants
In roughly half of transplant cases, we can use lower doses of chemotherapy and radiation prior to transplant. Even though the regimen calls for lower doses, the procedure isn’t meant to be less effective than a myeloablative transplant. The goal is to kill some of the cancer cells and less of the blood-making stem cells and to suppress the immune system just enough to allow donor cells to work.
Because a myeloablative transplant is associated with higher toxicity, many people are served better with a reduced-intensity transplant, especially if their cancer has been treated into remission before the transplant.
FAQs about blood and marrow transplant and cellular therapy
Marcos de Lima, MD, answers the most commonly asked questions about stem cell transplants.
CAR T-cell therapy
Chimeric antigen receptors (CAR) T-cell therapy is a type of cellular therapy that follows a similar treatment path to blood and marrow transplants. The main difference is that after the cells are taken from your blood, they’re manipulated in the laboratory to turn them into cancer-fighting cells. Then, they’re administered back to you. Like BMT procedures, chemotherapy is typically given prior to CAR T-cell therapy.
Outpatient bone marrow transplants
Blood and bone marrow transplants typically require you to stay in the hospital for several weeks or months, including during chemotherapy and the time following the transplant.
The OSUCCC – James is the only hospital in central Ohio offering transplants on an outpatient basis. The Outpatient Bone Marrow and CAR T-Cell Therapy Program allows people who meet certain criteria to avoid lengthy hospital admission and sleep at their own home or nearby lodging during their treatment.
Though not everyone is eligible for this type of stem cell transplant, people who are able to participate in the outpatient program often have improved outcomes and better quality of life.
Related resources
Blood and Marrow Transplant Program
Blood and Marrow Transplant Treatment
Blood and Marrow Transplant Care and Recovery
Stem Cell and Bone Marrow Donation
Blood and Marrow Transplant Research
Outpatient Bone Marrow Transplant
Blood and Marrow Treatment Team