Stem cell transplantation has drastically evolved, not only moving into different types of haematologic malignancies, but also into patient populations of different ethnicities, according to associate director of the Bone Marrow Transplant Program, Weill Cornell Medicine/NewYork-Presbyterian Hospital, Tsiporah B. Shore, M.D.
We live in a very multi-ethnic world, and it is more and more vital that all ethnic and racial groups needs can be accommodated.
With the addition of novel approaches such as haplo-cord and haploidentical transplants, an increasing number of patients are able to receive this necessary treatment.
Stem cell transplantation is a very important procedure that should be available for everyone. Looking at the unrelated registry, or even within families, there are very limited donors for many ethnic populations. It is vital that something is done about that so that transplants are available to everyone, even when donors are not available in the registry.
Shore’s centre has pioneered a new method called the haplo-cord transplant and also do cord transplantations and haploidentical transplantations – options which are fairly new and different to what was available five years ago thus enabling the entre to find donors for almost everyone.
What is the Haplo-Cord Protocol?
The haplo-cord protocol, which was pioneered at Weill Cornell Medicine, means that a haploidentical donor is combined with a cord. This allows a sibling, a parent, or a child that can serve as the haplo donor to be half of a match. According to Shore, it is easier to find a half-match within a family or even within the Registry.
This is then combined with the cord, of which there are many globally; the cord does not have to be perfectly matched. When the haplo and the cord are combined in this way, the haplo grows faster than the cord, so the haplo engrafts quickly, which shortens the time to engraftment so patients get less infections. The cord grows slower, but will eventually take over the body to the point where the haplo is no longer needed.
Is Stem Cell Transplantation Generally Well-Tolerated By Patients?
There are two kinds of stem cell transplant; one kind is where one’s own stem cells are used, and the one where stem cells from some sort of donor are used.
When stem cells are transplanted from a donor, there are many possible problems that could occur, from transplant all the way to infections, drug side effects, the period of pancytopenia where you might need transfusions, prophylaxis for various infections and, ultimately, graft-versus-host disease (GVHD), which is a reaction of the donor cells against the recipient and can be either acute or chronic.
The new method has eliminated a lot of GVHD by using in vivo T-cell depletion, which is used for virtually all of the allogeneic stem cell transplants at Weill Cornell Medicine. There have been no problems with relapse rates either, although slightly more viral infections are a possibility.