Blood & Marrow Transplant
For Patients & Families

Types of Stem Cell Transplants
At Sutter Cancer Center, Sacramento we perform autologous and allogeneic blood and marrow transplants.

Autologous
High-dose radiation or chemotherapy used to treat certain conditions also destroys bone marrow stem cells. To enable the patient to undergo the strength of treatment required, physicians remove and freeze stem cells. Once high-dose therapy is complete and the patient has rested for one to two days, the patient's own stem cells are returned intravenously (IV). This autologous method is the safest type of transplant because there is no concern about conflict between the stem cells and the patient.

Autologous transplants are considered for patients with:

• Hodgkin's disease (after failure of standard chemotherapy treatment)
• Non-Hodgkin's lymphoma
• Acute leukemias, especially acute myeloid leukemia
• Multiple myeloma
• Germ-cell tumors
• Other selected solid tumors (those that respond to chemotherapy but are high risk for recurrence)

The ideal candidate has shown response to chemotherapy, but has not been through multiple regimens and relapses. Typically, patients are under 80 years of age. Selection of patients for this procedure; however, depends on many clinical factors and is determined on an individual basis.

Standard (Full-Dose) Allogeneic Transplantation
In this instance, the stem cells are taken from a healthy donor and infused into the patient after the high-dose chemotherapy, with or without radiation. Most of the time, the patient's sibling (brother or sister) serves as the donor (matched related-sibling transplant). The patient and donor undergo a simple blood test called human leukocyte antigen (HLA) to see if the two are a match.

From a safety standpoint, this transplant is riskier than the autologous because there is always a concern about conflict between the patient's and the donor's immune systems, which can lead to the donor's immune cells fighting with normal patient tissues, a condition called graft-versus-host disease (GVHD).

The advantage of an allogeneic transplant is twofold. First, the stem cells are healthier and second, the donor's immune cells can also fight the cancer of the patient, a phenomenon known as graft-versus-tumor effect.

Occasionally, the patient has an identical twin. In this case, the transplant is called a “syngeneic” transplant.

Allogeneic transplants are considered for patients with:

• Acute leukemias in various stages of remission
• Multiple myeloma
• Selected cases of non-Hodgkin's lymphoma or Hodgkin's disease
• Aplastic anemia
• Myelodysplastic syndromes
• Myeloproliferative disorders
• Chronic lymphocytic leukemia

Candidates for this procedure must have a suitable donor. Usually the donor is selected by matching through human leukocyte antigen (HLA) testing. Also, patients typically are under 65 years of age.

Reduced-Intensity Allogeneic Transplantation
Non-myeloablative transplant, also called reduced-intensity or mini-allogeneicor mini-transplant, is another option for treatment. Patients receive a smaller dose of chemotherapy followed by allogeneic stem cell infusion. The procedure relies more heavily on the immune reaction of the donor cell against the cancer (graft-versus-tumor effect) and is relatively safe in patients up to 80 years of age, as well as in patients with other severe problems.

 In this instance, the patient receives small doses of chemotherapy, and then receives the donor's stem cells. The chemotherapy helps suppress the patient's immune system and allows the donor cells to settle in the patient and grow. The immune cells of the donor then attack the patient's cancer and try to eliminate it. GVHD can also happen with this transplant, but to a lesser degree than with the high-dose transplant.

Patients with multiple diseases are being treated with a mini-allogeneic transplant. The list of diseases treated continues to grow and include those previously listed for standard allogeneic transplants.