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Patients with leukemia, lymphoma, multiple myeloma, and myelodysplastic syndromes often require stem cell transplants (also called bone marrow transplants or BMT) to treat blood cancers.
Stem cell transplants are extremely complex. This is because patients need to purge diseased blood cells before they can be replaced by new, healthy cells. This is done using chemotherapy alone or in combination with radiation therapy. The replacement cells may be from the patient (called an autologous transplant) or from a donor (called an allogeneic transplant).
Stem cell and bone marrow transplants not only require a specialized medical team; Strong psychological support is also needed for patients who are often hospitalized for long periods of time and have to deal with many side effects.
2023 marks the 50th anniversary of the first bone marrow transplant from a donor to an unrelated patient at Memorial Sloan Kettering Cancer Center (MSK). This achievement was a breakthrough because it opened up the possibility for patients to find nonfamily donors and greatly expanded the use of these potentially lifesaving treatments.
Here, medical oncologist Miguel Ángel Perales, M.D., director of the Adult Bone Marrow Transplant Service, explains why MSK’s BMT program has remained a leader in the transplant field for the past 50 years. In addition to his role at MSK, Dr. Perales is serving this year as president of the American Society for Transplantation and Cell Therapy.
1. MSK has the largest BMT program in the New York City area.
In addition to having by far the largest and most experienced BMT program in the New York metropolitan area, MSK has one of the largest BMT programs in the nation. “In 2022, our adult BMT program performed 545 transplants, the most we have ever performed,” says Dr. Perales. “We also treat many children and adolescents through our MSK Kids pediatric BMT program. Our adult and pediatric BMT programs have performed over 10,000 transplants since their inception. We also treat many children and adolescents through our MSK Kids pediatric BMT program. The service offers treatments such as CAR T-cell therapy.” These treatments use a patient’s own immune cells to recognize and fight cancer.
2. MSK has experts who specialize only in stem cell and bone marrow transplants.
“Another reason we are recognized as leaders in our field is that everything we do is a team effort. We say this so often that it becomes like a cliché. It sounds good, but it’s true,” says Dr. Perales. “We have a lot of providers who are just focused on people receiving BMT and cell therapy.”
BMT team members collaborate with many other professionals across the hospital. “I don’t think there’s a single department in the hospital where BMT isn’t involved,” he added. “In many ways, the strength of this program is the strength of the entire organization.”
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The BMT team includes physicians primarily focused on patient care, as well as physicians focused on clinical research and clinical research.
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The team also includes physician assistants, nurse practitioners, and certified nurse practitioners who work exclusively in the BMT program. They develop close personal connections with patients undergoing this therapy.
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Clinical care coordinators, who are also nurses, focus on preparing patients for transplantation.
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The BMT program has a dedicated group of diet and nutrition experts as well as pharmacists.
3. MSK has experts who care for other medical needs of people undergoing stem cell transplants.
The BMT team relies on many members of MSK’s subspecialty medicine division, physicians who are focused on providing general medical care to people undergoing treatment for cancer.
BMT can affect many systems in the body. At MSK, we have pulmonologists, gastroenterologists, cardiologists, dermatologists, nephrologists, and more who have expertise in the difficult complications that can arise in connection with BMT. These professionals care for patients before, during, and after transplantation.
“We work particularly closely with infectious disease specialists at MSK, including specialists who only see patients with BMT and leukemia,” Dr. Perales points out. The types of chemotherapy used for blood cancers can leave patients severely immunocompromised. Infectious diseases are always a major concern.
4. MSK has unique programs that are not available at other hospitals.
MSK has a clinic that specializes in treating graft-versus-host disease, a serious complication of BMT using donor cells. This side effect occurs when the donor’s immune cells attack the recipient’s healthy tissue. The clinic is co-led by hematology-oncologist Doris Ponce, M.D., his M.S. Dr. Andrew Harris is a pediatric hematology-oncologist and BMT specialist. and dermatologist Dr. Alina Malkova.
We also have options for many people who may not be able to find a compatible donor. This is a particular challenge for people from Southern European, Asian, African, Hispanic, Middle Eastern, or mixed ethnic backgrounds. MSK’s cord blood transplant program uses stem cells from the umbilical cords of newborns donated to the cord blood bank. This approach has saved many patients at MSK.
5. MSK research strives to improve BMT and make it more accessible.
MSK is nationally recognized for its research efforts focused on new ways to make transplants more effective for more people. One of the big challenges is controlling the disease well enough so that patients are healthy enough to receive a transplant. “Our ability to do that is improving with the use of new chemotherapy as well as targeted therapies and immunotherapies,” Dr. Perales says.
We also focus on making transplants available to everyone who needs them. At the American Society of Hematology meeting in December 2022, a team led by hematologic oncologists Bograkha Gyulkoca, MD, and Kartik Nath, MD, MBBS, will discuss how MSK is helping overcome the barriers to bringing this therapy to patients. We reported on how we are working on this.
In addition to using umbilical cord blood transplants, MSK has developed other methods that allow people without a complete match to receive a transplant from a partially matched family member or unrelated donor. did. This alternative donor program is led by BMT expert Dr. Brian Shafer. “When I consult with patients, one of the first things I say is, ‘We are confident we will find you a donor,'” Dr. Perales says.
6. MSK also treats rare cancers through stem cell transplants.
BMT typically treats common blood cancers such as leukemia, lymphoma, multiple myeloma, myelodysplastic syndromes, and less common diseases such as systemic amyloidosis and central nervous system (CNS) lymphoma. can also be treated. MSK has experts who specialize in transplant treatment for these rare cancers.
The MSK Kids team also uses BMT to treat children with certain inherited non-cancerous blood disorders. “With promising treatments like gene therapy for sickle cell anemia gaining approval from the U.S. Food and Drug Administration, we look forward to expanding care to adults with genetic disorders,” Dr. Perales noted. do.
7. MSK offers BMT care in many locations outside of Manhattan.
People with BMT can receive some of their treatment at regional locations including MSK Commack and MSK Nassau on Long Island and MSK Westchester. It will soon be available at MSK Monmouth in New Jersey.
MSK’s newest location in Brooklyn, Memorial Medical Care (PC), also includes experts in blood cancer treatment and bone marrow transplants. “We are excited to now be able to offer more services to patients who live in New York City but find it difficult to travel to Manhattan,” says Dr. Perales.
8. For 50 years, MSK has been a leader in providing innovative BMT treatments.
In 1973, MSK pediatric oncologist Richard O’Reilly, M.D., pioneered the development of the first bone marrow transplant for pediatric patients without matching siblings. Patients received bone marrow fluid from unrelated donors who were found to be compatible. This type of transplant has dramatically expanded treatment options for blood cancer patients of all ages, not just in MSK, but around the world.
