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Find JobsSutter Medical Center, Sacramento, part of Sutter Cancer Centers, we perform both autologous (using your stem cells) and allogeneic (using donor stem cells) blood and marrow transplants. While most transplants are performed using stem cells collected from the blood (peripheral blood stem cells) or from the umbilical cord (at birth), we also perform bone marrow transplants when indicated.
High-dose radiation or chemotherapy used to treat certain conditions also destroys bone marrow stem cells. To enable you to undergo the strength of treatment required, physicians remove and freeze stem cells. Once high-dose therapy is complete and you have rested for one to two days, your own stem cells are returned intravenously. 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 if you have:
Ideal candidates are usually younger than 80 and have responded to chemotherapy but have not had multiple regimens and relapses. Selection for this procedure depends on many clinical factors and is determined on an individual basis.
In this instance, the stem cells are taken from a healthy donor and infused into you after high-dose chemotherapy is given, with or without radiation. Most of the time, your sibling serves as the donor, called a matched related-sibling transplant. When someone has an identical twin, the transplant is called a “syngeneic” transplant. The patient and donor undergo a simple blood test called human leukocyte antigen 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 your and the donor's immune systems, which can lead to the donor's immune cells fighting your normal tissues, a condition called graft-versus-host disease. However, 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.
Allogeneic transplants are considered if you have:
Candidates for this procedure must have a suitable donor. Usually the donor is selected by matching through human leukocyte antigen testing. Also, patients are typically younger than age 65.
Non-myeloablative transplant, also called reduced-intensity or mini-allogeneic mini-transplant, is another option for treatment. You 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 people up to 80 years of age, as well as in patients with other severe problems.
In this instance, you receive small doses of chemotherapy and then receive the donor's stem cells. The chemotherapy helps suppress your immune system and allows the donor cells to settle and grow. The immune cells of the donor then attack the patient's cancer and try to eliminate it. Graft-versus-host disease can also happen with this transplant, but to a lesser degree than with the high-dose transplant.
People with multiple diseases are sometimes treated with a mini-allogeneic transplant. The list of diseases treated continues to grow and includes those previously listed for standard allogeneic transplants.
