Stem Cell / Bone Marrow Transplant: Autologous Stem Cell / Bone Marrow Transplant
Alternate Names: bone marrow transplant, BMT, stem cell transplant, SCT
What is an autologous stem cell / bone marrow transplant?
An autologous stem cell / bone marrow transplant replaces damaged or destroyed bone marrow stem cells with healthy ones donated in advance by the patient. The “auto” prefix means “self” or “oneself.” Stem cells from the patient’s own blood and/or bone marrow are collected and used in the transplant. (Learn about transplants using donor cells from other people: allogeneic stem cell / bone marrow transplant.)
Stem cells are produced in the spongy area of bones known as marrow. These cells develop into all types of blood cells in the body. In an autologous stem cell / bone marrow transplant, the transplanted stem cells grow and become normal blood cells that help fight disease.
What are autologous stem cell / bone marrow transplants used to treat?
These transplants are used to treat blood-related cancers and other disorders, including:
What happens before an autologous stem cell / bone marrow transplant?
Clinicians decide whether the patient can have the transplant:
- The patient is tested for infectious diseases in the same way as people donating blood.
- A medical exam shows whether the patient will be able to tolerate the collection process.
- Stem cells are collected (harvested):
- Stem cells from the blood and/or bone marrow are taken from the patient and frozen.
- If marrow is to be used, doctors usually insert a needle into a bone (often the pelvis) to pull out the marrow.
- Another method uses blood stem cells that circulate throughout the body. This method obtains stem cells from the patient’s vein in a method similar to a blood donation.
Before the cells are transplanted, the patient receives treatment to destroy as many abnormal cells as possible and to increase the chance of transplant success. The patient may receive chemotherapy, radiation therapy or both. At the same time that these therapies kill cancer cells they can also destroy many healthy blood cells.
- Chemotherapy (“chemo”) - uses powerful medicines to kill cancer cells or stop them from growing (dividing) and making more cancer cells.
- Chemo may be injected into the bloodstream, so that it can travel throughout the body.
- Some chemo may be given by mouth.
- Combination therapy uses more than one type of chemo at a time.
- Ablative therapy (also called myeloablative therapy) - uses high-dose chemo to kill both healthy and cancerous bone marrow cells, leaving the transplanted cells more room to grow. The dose can be changed depending on your child’s ability to tolerate this strong treatment. A “mini-transplant” uses lower, less-toxic chemo doses and/or radiation.
- Radiation therapy - uses high-energy X-rays or other types of radiation to kill cancer cells or stop them from growing.
How are autologous stem cell / bone marrow transplants done?
After the chemo and / or radiation treatment is complete, the patient’s healthy stem cells are transplanted into the bloodstream:
- The procedure is similar to a blood transfusion.
- The cells travel through the blood until they reach the marrow and start growing new, healthy cells.
What problems can occur with autologous stem cell / bone marrow transplants?
Patients receive their own stem cells, so there is no risk that the immune system will react to the transplanted cells as foreign and attack or reject them (graft-versus-host disease).
Problems that may occur include:
- Sometimes stem cell harvesting also collects cancer cells, which may cause the cancer to return.
- Infection is common because fewer white blood cells are present to fight it.
- Fewer red blood cells can cause anemia.
- Low platelet levels can cause blood clotting problems and dangerous bleeding.
What are the survival rates for autologous stem cell / bone marrow transplants?
Survival in children following autologous stem cell / bone marrow transplantation depends on:
- What type of cancer the child has
- How well the child responded to earlier treatment
- How far the cancer has spread, if it has, to other areas of the body
In a recent study, children with acute promyelocytic leukemia had an overall five-year survival rate of 82 percent following autologous stem cell transplant.
Patients with solid tumors that have relapsed or spread and who have a certain protein called KIR on the cancer-fighting immune cells (natural killer cells), have a survival rate of 70 percent following autologous stem cell transplant.
Why come to St. Jude for autologous stem cell / bone marrow transplantation?
- St. Jude is the only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children.
- St. Jude has created more clinical trials for cancer than any other children’s hospital in the United States.
- The nurse-to-patient ratio at St. Jude is unmatched— averaging 1:3 in hematology and oncology, and 1:1 in the Intensive Care Unit.
- The St. Jude Transplant Program has extensive experience, having performed more than 2,500 transplants since 1982.
- St. Jude is accredited by the Foundation for the Accreditation of Cellular Therapy (FACT) for autologous and allogeneic peripheral blood and marrow transplantation in children and adults.
- To improve outcomes and reduce side effects associated with transplants, doctors in the St. Jude Transplant Program work closely with laboratory scientists to rapidly move discoveries from the lab to the clinic.
- St. Jude support staff members have been specially trained to care for children receiving autologous stem cell / bone marrow transplants.
- St. Jude researchers are studying different chemotherapies for pre-transplant conditioning to prevent relapse. Scientists are also researching how to prevent relapse by giving immunotherapy after transplantation.
The St. Jude Web site is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through this site should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, you should consult your health care provider.