A bone marrow or stem cell transplant may help patients who develop certain cancers, specific hereditary conditions or those whose cancer treatment from chemotherapy or radiation therapy has caused problems by destroying normal cells in the bone marrow.

For these patients whose bone marrow is not functioning properly, the transplant procedure replaces the non-functioning or abnormal cells with healthy cells. In some cases, a bone marrow or stem cell transplant may be the most effective treatment for patients with certain forms of cancer.

For patients with hereditary or acquired disorders resulting in abnormal blood cell production, transplantation of healthy bone marrow can be life-saving. Transplanted bone marrow and stem cells work to restore production of white blood cells, red blood cells and platelets, all needed for health and to fight against disease.

Common indications for bone marrow/stem cell transplantation

• Non-Hodgkin's lymphoma
• Hodgkin's disease
• Multiple myeloma
• Acute myeloid leukemia
• Chronic myeloid leukemia (CML)
• Other myeloproliferative disorders
• Acute lymphoblastic leukemia (ALL)
• Chronic lymphocytic leukemia
• Myelodysplastic syndrome
• Severe aplastic anemia

• Testicular cancer

Patient Evaluation

The evaluation process begins with a patient consultation with a transplant specialist and a medical assessment to determine eligibility for transplantation. Important considerations include the patient's overall health, major organ function, and current disease state.

The medical assessment is followed by a psychosocial evaluation performed by a social worker to explore existing support systems and identify any concerns that could hinder a successful recovery from transplant. The entire patient evaluation process is completed in about one to two weeks on an outpatient basis.

Once all the testing is completed, the Bone Marrow Stem Cell Transplant physician team reviews the results and makes a collective decision regarding the candidacy for transplant. The decision then is shared with the patient, the family, and the referring physician.

Every patient accepted to the Henry Ford Bone Marrow Stem Cell Transplant Program receives a customized care plan. The length of time before transplant depends on the patient's medical status, the stage of the disease, and whether the transplant involves use of the patient's own cells (autologous transplant) or cells from a related or unrelated donor (allogeneic transplant). Patients requiring allogeneic transplantation from an unrelated donor will be registered with the National Marrow Donor Program, the network to help find a matching donor.

Selecting the Donor Type

Henry Ford's transplant specialists will help determine the best type of transplant for each patient. The type of transplant selected depends on several factors:

• Does a patient's cancer involve the bone marrow
• Does the condition allow use of the patient's own cells
• Does the patient's condition require a related or unrelated donor
• Is there a related donor available
• How will the donor cells be supplied: through bone marrow, blood stem cell, or cord blood

The three types of transplants are autologous (patients receive their own cells for treatment), allogeneic (patients receive matching cells from a related or unrelated donor), and syngeneic (a form of the allogeneic transplant used for identical twins only).

• Autologous: The patient's own stem cells are obtained, processed, and safely stored in liquid nitrogen until the time of transplant.
• Allogeneic: Stem cells are obtained from a healthy donor who is either related or unrelated to the patient.
  • Related Donor: Most often the donor will be a brother or sister. Since the donor's white cells, if unmatched, will attack the patient's body, the white cell type is matched by a test called HLA typing.  If the sibling matches the patient on all six HLA sites, he or she is considered a good match.  If a sibling is not available or does not match, the search for an unrelated and/or less perfectly matched donor can begin.

  • Unrelated Donor: Unrelated donor options include bone marrow, stem cells, or cord blood stem cells. The search for an unrelated donor is done through the National Donor Marrow Program which contains a pool of approximately 7 million volunteers nationally and internationally who are willing to donate to those in need. Locating a matched volunteer is a long process. If an acceptable match is not found through the National Donor Marrow Program, other international registries are tapped.

Selecting the Harvest Method

Healthy bone marrow contains red blood cells, white blood cells, and platelets that work to keep the body functioning properly. Bone marrow is found in a soft, fatty tissue inside bones. Bone marrow can be used for transplants as can peripheral blood stem cells.

Stem cells are found in bone marrow, in the circulating bloodstream, and in umbilical cord blood. Stem cells have the ability to produce red blood cells, white blood cells, and platelets, which makes them ideal for transplantation.

Stem cell transplantation and marrow transplantation differ mainly in the method by which stem cells are collected. In bone marrow transplantation, bone marrow is collected from the hip, chest, or pelvis bone in a surgical procedure.

With stem cell transplantation, peripheral blood stem cells are collected from the bloodstream through a specialized process called pheresis. Improved methods for collecting and storing peripheral blood stem cells have made this type of transplantation the most commonly used. However, in rare situations, stem cells must still be procured from bone marrow.