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About

BONE MARROW TRANSPLANTATION AND CELLULAR THERAPY

Bone marrow transplantation is the replacement of a patient’s damaged or destroyed bone marrow with new bone marrow cells. Bone marrow transplantation can be a lifesaving method in acute leukemias and lymphomas, which are resistant to standard chemotherapy. Stem cells may be collected from a person’s own body or that of another person. This other person is called a donor.

Bone marrow transplantation is performed for individuals who have diseases affecting the bone marrow, including leukemia, myelodysplastic syndrome, other hematological malignancies (such as lymphoma and multiple myeloma), and aplastic anemia, in which the bone marrow cannot provide adequate blood-forming cells. It can also be used in numerous chemotherapy-unresponsive cancers, such as testicular cancer, neuroblastoma, and medulloblastoma, and congenital disorders, such as thalassemia, sickle cell disease, porphyrias, and severe immunodeficiency disorders.

 

Autologous transplantation is the procedure of using the person’s own stem cells. This method of transplantation is mainly used in multiple myeloma and lymphoma patients.

Fully matched allogeneic transplantation is the procedure of using another person’s fully compatible stem cells. This is preferably a fully matched sibling of a patient.

Matched unrelated donor transplantation is performed for patients who do not have a fully matched sibling. A donor is found by searching national and international bone marrow banks.

Haploidentical transplantation is performed for patients who do not have a fully matched sibling and are in urgent need of transplantation. The donor is a half-matched sibling, parent, or child of the patient. This is a relatively new method and can be as effective as matched unrelated donor transplantation in experienced centers.

  • If the patient does not have a related donor, national and then international (DKMS and BMDW) databases are searched for an unrelated donor. A 10-parameter high-resolution HLA typing test will be performed to check donor registries.

  • Once the patient’s HLA type is known, a preliminary search can be performed. The preliminary search is a computerized search designed to identify potential bone marrow donors that have similar HLA antigens.

  • If the preliminary search is successful in identifying potential donors, a formal search is initiated. During this process, potential donors are contacted by the bank, and blood samples are obtained to confirm HLA typing and to perform other screening tests. These additional blood tests are specialized and designed to determine which donor is the best possible match.

  • An unrelated donor search is a complex and time-consuming process. On average, it takes up to three months to complete the search process. Therefore, it is imperative to begin the unrelated search process as soon as possible.

  • Once an adequate number of stem cells have been collected from the donor, they will be sent to Altunizade Acıbadem Transplant Center for the transplant procedure.

allogeneic transplantation

  1. In all types of allogeneic transplantation, both the patient and donor are analyzed via extensive pre-transplant tests, including routine blood, cardiological, respiratory, and dental tests. HLA tests are repeated to check compatibility.

  2. In haploidentical transplantation, tests can predict whether donor cells have a high chance of rejection by the patient. If these tests are positive, then a new donor is requested.

  3. These tests usually take 4–5 days, and if the donor is suitable, mobilization of stem cells from the donor is commenced. When the donor arrives at the hospital, a catheter is inserted into each arm, and stem cell collection is performed using an apheresis machine until enough cells are obtained for the patient. This usually takes about two days.

  4. Once an adequate number of stem cells have been collected from the donor, it is time to start the transplant procedure. The donor may then return to their home country. The duration of the stay for the donor is approximately 10 days.

  5. The patient is admitted to the hospital, and a central catheter is inserted into a neck vein. This catheter is used throughout the transplant procedure to provide chemotherapy and other medications, such as antibiotics, allow blood and platelet transfusion, and perform blood tests.

  6. The duration of chemotherapy for full HLA-matched allogeneic transplants is six days, for matched unrelated donor transplants is seven days, and for haploidentical transplantation is nine days. Following a day of rest, the donor stem cells are infused through the catheter in the neck in a similar manner to transfusing blood.

  7. Following chemotherapy and during the latter parts of the transplant, the patient usually has chemotherapy-induced loss of appetite and diarrhea. Therefore, there is a need for blood and platelet transfusion. Pyrexia is frequent and is treated with antibiotics administered through the catheter in the neck.

  8. Stem cells start to engraft approximately 10 days after the transplant. The patient’s symptoms (loss of appetite, diarrhea, etc.) start to improve at this stage. However, the patient will only be ready to leave the hospital after another 5–7 days, as it is still necessary to stabilize blood counts and electrolytes and establish adequate oral feeding. Hence, the total duration of the hospital stay is approximately one month.

  9. Once the patient is clinically stable, they are discharged from the hospital and looked after in approved apartment hotels where they can stay with their families. Transport is provided for clinic controls and follow-up blood tests. A translator is always present for both in-patient and out-patient purposes.

  10. Bone marrow analysis is usually performed one month after the transplant to make sure that there is no disease and check that the cells indeed belong to the donor.

  11. When the patient is determined to be in stable condition, they are transferred to their home country. The estimated time from the day of admission to the return date is approximately two to three months, but this may change if there are problems, such as ongoing infections or slow rising blood counts.

  12. If there are complications such as infections that do not respond to standard treatments during their stay in their home country, the patient may return to Altunizade Acıbadem for further care.

CAR T-cell therapy

CAR T-cell therapy is a new type of cancer treatment using immune cells to attack tumors. CAR T-cell treatment is a form of immunotherapy that modifies the targeting mechanism of the immune system to fight cancer. The therapy is customized for each patient, using T cells, the major component of our immune system. In CAR T cell immunotherapy, T-cells are derived from the body and genetically engineered in laboratory settings to produce specific chimeric antigen receptors (CARs). When modified T-cells are infused back into the patient, the new receptors enable them to identify particular antigens of the cancer cells and destroy the tumor.

Up to date, CAR T-cell therapy is approved for refractory B-cell Acute Lymphoblastic Leukemia (B-ALL), B-cell Lymphoma, and Multiple Myeloma. The CAR-T treatment carries the CD-19 receptor. It can be considered for patients with post-transplant relapsed or refractory B-cell Acute Lymphoblastic Leukemia and Non-Hodgkin Lymphoma (NHL). Our product will be ready in the next 1 year for clinical trials on multiple myeloma.

For successful CAR T-cell therapy, the patient should be in good overall health, and the tumor load should be low. Therefore, our physicians will mostly prescribe bridging chemotherapy and/or radiotherapy before the procedure to increase treatment success.

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