Types of Stem Cell Transplant for Blood Cancer

UPMC Hillman Cancer Center offers several types of stem cell transplants, including:

• Autologous transplant is when stem cells are collected from a patient prior to high dose chemotherapy treatment and then re-introduced into the same patient’s blood after treatment. This allows the use of very high doses of chemotherapy that are effective in treating blood cancer cells, but would kill nearly all of the normal blood cells in the patient.
• Allogeneic transplantation is when patients receive stem cells collected from a related or unrelated donor who is a close genetic match. In addition to the allowing the delivery high doses of chemotherapy, immune cells in the donor can recognize cells in the patient, including blood cancer cells, as foreign. These cells can then attack the cancer. This process is called “graft-versus-leukemia”. Unfortunately, donor immune cells can also attack normal cells in the patient, causing “graft-versus-host disease”. In order to help to prevent graft-versus-host disease or make it less severe, all patients receive immunosuppressive medications. These medications also reduce the risk that the patient’s cells will reject the donor blood stem cells, which is very uncommon. Allogeneic transplantation is most commonly used to treat leukemias and myelodysplastic syndromes but is also employed in treatment of some patients with lymphoma.

Allogeneic Stem Cell Transplant

Allogeneic hematopoietic stem cell transplantation is the oldest and most widely used form of adoptive immunotherapy. UPMC Hillman Cancer Center has performed allogeneic stem cell transplants for more than 30 years. Some blood cancers that are treated with allogeneic stem cell transplantation at UPMC include:

• Leukemias
• Lymphomas
• Myelodysplastic syndrome

In the days before the stem cell infusion, patients receive a “conditioning regimen” which consists of chemotherapy, sometimes combined with radiation therapy. The purpose of the regimen is to kill residual cancer cells, to suppress the immune system of the patient which helps to prevent rejection, and to “make room” in the bone marrow for the new blood stem cells. A day or two prior to the infusion of the stem cells, immunosuppressive drugs are begun to reduce the risks of graft-vs-host disease and rejection. Finally, the donor stem cells are infused into to the recipient’s bloodstream. The stem cells will find their way to, and begin to grow into, the recipient’s bone marrow.

The new donor-derived immune cells may attack and destroy recipient cancer cells that the patient’s own immune cells were not able to recognize. This process is called the graft-versus-cancer effect.

Complications of allogeneic stem cell transplant

Complications of allogeneic stem cell transplant include infection and graft-versus-host-disease, which occurs when donor-derived immune cells attack the recipient’s normal cells. Graft-versus-host-disease can occur in the skin, liver, and gastrointestinal tract. During transplant recovery, recipients continue taking immunosuppressive drugs to prevent graft-versus-host-disease. Physicians and researchers at UPMC Hillman Cancer Center are committed to understanding and identifying the causes behind graft-versus-host disease and graft-versus-cancer effect to maximize the benefits of donor cells while minimizing the complications.

UPMC Hillman Cancer Center also offers clinical trials in stem cell transplantation that test techniques to prevent graft-versus-host disease and new ways to treat it. One of our allogeneic stem cell transplant trials is based on the research of Warren Shlomchik, MD, the co-director of UPMC’s Stem Cell Transplant and Cell Therapy program. Dr. Shlomchik’s group discovered that a type of immune cell, called a naïve T cell, is especially powerful in causing graft-versus-host-disease. He and colleagues at the Fred Hutchinson Cancer Research Center developed a method to remove naive T cells from donor stem cells before introducing them into recipient’s blood. Thus far the results from clinical trials are very encouraging. Learn more about this clinical trial.

Autologous Stem Cell Transplants

Autologous transplantation uses a patient’s own stem cells to replace stem cells killed by high doses of chemotherapy or radiation used during cancer treatment. At UPMC, we use autologous transplants to treat a number of blood cancers, including lymphoma and multiple myeloma.

In an autologous stem cell transplant, the patient is given medications that signal stem cells to multiply and move from the bone marrow to the bloodstream. This process takes five to 10 days and, depending on the patient and is done as an outpatient. The stem cells are then collected from the patient’s blood through a process called apheresis, which takes several hours and may be repeated over two to three days. The stem cells are then frozen and stored.

In the days before the transplant, patients receive a conditioning regimen that includes high dose chemotherapy. After the chemotherapy is completed, the stem cells are infused back into the patient’s bloodstream. These stem cells find their way back into the patient’s bone marrow and restart production of blood and immune cells. Typically, patients have adequate blood counts by 2-3 weeks after the stem cell infusion.

There is no risk of graft-versus-host disease after autologous stem cell transplant as the patient is receiving his/her own cells.

Learn more about the details of the stem cell transplant process here.

Contact Us About Stem Cell Transplant for Blood Cancer

To learn more or make an appointment, call the Mario Lemieux Center for Blood Cancers at 412-864-6600.