Bone Marrow Transplantation & Cellular Therapy Division



The mission of the Division of Bone Marrow Transplantation and Cellular Therapy at St. Jude Children’s Research Hospital is to provide outstanding care for all patients who need a hematopoietic stem cell / bone marrow transplant.

Under the Bone Marrow Transplantation Program at St. Jude, one of the largest pediatric programs in the world, a total of more than 1,000 transplants have been performed since 1982, including 150 transplants in the last year. Our patients are newborns, infants, children, adolescents and young adults, who have a malignant or nonmalignant life-threatening disorder that is treatable with a hematopoietic stem cell / bone marrow transplant with autologous cells or allogeneic cells.

Children with life-threatening illnesses who are undergoing hematopoietic stem cell / bone marrow transplant require highly specialized resources and experienced staff, such as those available at St. Jude, to meet their physical, psychological, social, and developmental needs. At St. Jude, a multidisciplinary team of health care professionals provides advanced treatment, and all of our patients are enrolled on clinical research protocols that are designed to give patients the best possible chances of survival with the fewest possible complications when they undergo the transplantation procedure.

The Transplant Unit at St. Jude is a closed, 16-bed unit specifically designed for the care of immunocompromised patients. On the same floor, there are offices for the transplant coordinator, clinical nurse specialist, social worker and a play area operated by Child Life Specialists. Facilities for cell processing and storage are available in a Human Applications Laboratory.

The Transplant Program at St. Jude is approved by the Children's Oncology Group (COG) and the National Marrow Donor Program (NMDP).


Allogeneic stem cell / bone marrow transplants

Our allogeneic stem cell / bone marrow transplant program treats acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), non-Hodgkin lymphoma (NHL), Hodgkin lymphoma, myelodysplastic syndrome (MDS), chronic myeloid leukemia (CML), juvenile chronic myeloid leukemia (JCML), melanoma, and other high-risk malignancies.

Our program also treats genetic disorders such as adrenoleukodystrophy, Langerhans cell histiocytosis (LCH), hemophagocytic lymphohistiocytosis (HLH), sickle cell disease, osteopetrosis, osteogenesis imperfecta, metabolic storage disorders, bone marrow failure syndromes, aplastic anemia, X-linked lymphoproliferative disorder, and immunodeficiencies (e.g., Wiskott-Aldrich syndrome and severe combined immunodeficiency syndrome or SCIDS).

Allogeneic donors may be a matched sibling, a mismatched family member, or an unrelated donor.


Research

Although we have a strong background in the use of unrelated donors, we are investigating the use of mismatched family members as donors so that we may extend the transplantation program to include patients who do not have a matched sibling or unrelated donor.

Our program is also developing novel natural killer (NK) cell transplant approaches to treat leukemia that fails to respond to chemotherapy.  By combining bone marrow transplantation and natural killer cell transplantation, we aim at reducing the likelihood of complications such as leukemia relapse, graft versus –host disease, graft rejection, and infections.  In December, 2004  our program successfully performed the world’s first combined bone marrow and NK cell transplantation.  We are also using NK cell transplant to prevent leukemia relapse after completion of AML treatment.  Our lab pioneers novel  NK cell typing technologies to select the best NK cell donor.  Novel gene modified approaches are used to augment the anti-leukemia activity of donor NK cells.

We are also extending curative therapy to children with sickle cell disease or other nonmalignant disorders. We are using novel, potentially curative therapies for this group of patients to decrease transplant-related toxicity and to allow patients lacking matched sibling or unrelated donors to undergo stem cell / bone marrow transplants.

Other studies include the investigation of donor-recipient chimerism and the development of assays to determine the minimal residual disease (MRD) remaining after transplantation. In addition, to try to understand the immunologic mechanisms underlying the graft-versus-tumor effect, we are evaluating the use of nonmyeloablative or reduced-intensity conditioning regimens for relapsed or refractory leukemias and solid tumors.


Autologous stem cell / bone marrow transplants

Our autologous stem cell / bone marrow transplant program treats a variety of cancers, such as neuroblastoma, retinoblastoma, Wilms tumor, medulloblastoma, atypical teratoid/rhabdoid tumor, Hodgkin lymphoma, non-Hodgkin lymphoma, rhabdomyosarcoma, desmoplastic small round cell tumor, and Ewing sarcoma, which is also called peripheral neuroepithelial tumor (PNET).

Research is focused on methods to decrease the likelihood of relapse for patients with these diseases by piloting novel conditioning regimens, studying methods of post-transplant immunotherapy, and using new stem cell manipulation methods such as tumor cell purging.


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