Treatment

Bone Marrow Transplant

Bone marrow transplantation and stem cell transplantation both refer to a procedure in which healthy hematopoietic (blood producing) stem cells are infused into your body to replace damaged or diseased bone marrow that fails to produce enough healthy blood cells of its own. It can use cells from your own body (called autologous transplant) or from a related or unrelated donor (an allogeneic transplant). Hematopoietic stem cells can be harvested directly from the bone marrow in the back of the hip (bone marrow transplant) or from the bloodstream after treatment to mobilize these cells from the marrow into the blood (stem cell transplant). Most transplants at the center are stem cell transplants.

Autologous and allogeneic transplantation can be a successful treatment for a variety of cancers, including: acute and chronic leukemia, lymphoma, non-Hodgkin lymphoma, Hodgkin disease, multiple myeloma, and some non-malignant blood diseases. The bone marrow and stem cell transplant program at the Siteman Cancer Center is one of the largest in the world, performing about 500 transplants a year, and more than 6,000 since 1982.

Our physicians use the latest clinical techniques and resources to perform bone marrow and stem cell transplantation. Whenever appropriate, they recommend that patients participate in clinical trials to test the safety and effectiveness of new, cutting edge approaches to prevent, diagnose and treat cancer. At any given time, Siteman offers more than 40 therapeutic clinical trials for patients with leukemia, lymphoma, multiple myeloma and related disorders, including studies that incorporate bone marrow and stem cell transplantation. The bone marrow and stem cell transplant program at Siteman is a Core Center and Steering Committee Member for the BMT Clinical Trials Network, a National Institutes of Health-funded, nation-wide consortium of leading transplant centers.

In recent years, Washington University Physicians at Siteman have conducted clinical studies that led to the approval of novel drugs to mobilize, or harvest, stem cells for transplant in patients with non-Hodgkin lymphoma and multiple myeloma, as well as effective treatments for elderly patients with acute myelogenous leukemia (AML). They were the first to use a novel suicide gene approach for gene therapy to control graft-versus-host disease, a serious complication of transplantation. They have pioneered novel pharmacologic approaches to reprogram cells of the immune system to prevent graft versus host disease (GVHD). And unlike many top hematologic cancer centers, Siteman’s bone marrow and stem cell transplant program is fully integrated. The same doctors managing the blood disease oversee the transplant process. The need for transplant is customized to the individual patient.

Transplant process

The process begins with the collection of blood-producing stem cells. To collect stem cells from the blood, these cells are first “mobilized” from the bone marrow into the bloodstream using medication, then collected from a vein and processed through a special machine as an outpatient procedure. To collect stem cells from the bone marrow, they are collected through a needle from the back of the hip (iliac crest) during a 1-2 hour surgical procedure under general or spinal anesthesia, following which the donor is typically admitted to the hospital for a 24-hour observation period.

Once the collection of stem cells is complete, patients undergoing autologous transplant are admitted to the hospital to receive a high-dose chemotherapy conditioning regimen to eliminate residual cancer cells from the body. For patients undergoing allogeneic (donor) transplant, the conditioning regimen is often, but not always, initiated simultaneously with the process of collecting stem cells from the donor. Next, the previously collected stem cells are infused (transplanted) through an intravenous catheter. During the following seven to 14 days, the blood counts fall to low levels because the bad marrow was destroyed by the chemotherapy, and it takes time for the newly infused stem cells to start producing blood. During that time, there is a high risk of infection due to low white blood cells, and of bleeding due to low platelets, and frequent need for transfusions. The duration of hospitalization typically averages three to four weeks, but varies from patient to patient and is based on the type of transplant.

Referrals

Siteman offers a team of referral specialists who assist providers seeking treatment for their patients. To request an appointment, call 314-747-3046 or 877-251-6485 toll-free from 8 a.m. to 4:30 p.m. Monday through Friday.

Referrals also can be made online through a secure appointment request service.

To expedite the referral process, our referral specialists may ask you to fax records to us at 314-454-8103.

The mailing address is:
4901 Forest Park Ave
Center for Outpatient Health 8th Floor
St. Louis, MO 63108
Mail Stop: 90-75-563

If appropriate, a financial specialist is available to answer questions about health insurance and identify resources for expenses related to cancer care.

Our referral specialists also handle requests for hospital-to-hospital transfers during regular business hours. Referring physicians will be quickly connected to a specialist physician on staff at Barnes-Jewish Hospital who can authorize a transfer. After-hours requests can be made by calling the hospital’s Doctors’ Access Line at 314-747-3251 or 800-252-3627.