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Resource Guide for Bone Marrow/Stem Cell Transplant
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Introduction

The ABCs of BMT! BMT, PBSCT, HSCT, bone marrow transplant, stem cell transplant, peripheral blood stem cell transplant, blood cell transplant….so many words and letters it looks like alphabet soup….do they all mean the same thing? In the area of stem cell transplantation there has been a lack of worldwide scientific agreement on a single terminology. An understanding of the history of this treatment method offers some explanation about why so many different terms are used. Direct collection from the bone marrow was the first source of hematopoietic stem cells (the cells capable of producing red cells, white cells and platelets), hence the treatment was initially called a bone marrow transplant or BMT. The discovery of hematopoietic stem cells in the peripheral circulation similar to those harvested from the bone marrow led to the term “peripheral blood stem cell transplant” (or PBSCT). Currently, the peripheral blood is the major source of stem cells rather than bone marrow, and so a more general term of “hematopoietic stem cell transplant” (HSCT) has been adopted to include situations in which the stem cells may be collected from the peripheral blood, directly from the bone marrow, or even from the placenta (cord blood transplant).

For an autologous transplant, first the stem cells are collected from the patient; then the patient is given high dose chemotherapy. After the high dose chemotherapy, the patient is given back his/her own stem cells. However, the use of the term ‘transplant’ for this procedure has also led to confusion. An autologous transplant is not really a transplant; it is actually just a reinfusion of the person’s own stem cells.

When talking about a stem cell transplant one must consider both the source of the stem cells (from the patient, from a related donor, from an unrelated donor), and the way in which the cells are collected (from the peripheral blood, from the bone marrow space directly, or from the placenta after delivery). Using the latest research, the health care team will make a recommendation about which stem cell source and which method of collection is most appropriate to the medical needs of the patient.

Throughout this publication, we will be using the term “stem cell transplant” and its abbreviation SCT, which includes bone marrow, peripheral blood, and cord blood transplant, related or unrelated.

Physicians always caution against using the term “miracle” in connection with stem cell transplant. It is, as they remind us, a modern medical procedure involving some risk. It comes with no guarantee. However, few would deny that there has been tremendous progress in the field. Examples include:

• The acceptance by most insurance companies that SCT is a standard rather than experimental treatment for a number of diseases. The result has been an increase in the number of insured patients.
• The list of diseases and conditions with treatment potential from SCT has steadily increased. Once considered a “last resort” for leukemia, SCT is now successful for a number of illnesses and performed earlier in the course of the disease.
• Thanks in part to media coverage of transplant patients and their stories, stem cell transplant has received greater awareness and acceptance. Due to this exposure donor registries throughout the world have increased their number of volunteers. However, increasing the number of donors on the registries is still a critical concern for minorities who identify themselves as Black or African Americans, American Indians or Alaska Natives, Asians, Hawaiian or Other Pacific Islanders, Hispanic or Latino, or mixed race individuals.
• The maximum age at which patients are considered for SCT has increased due to advances in the SCT field. The use of reduced intensity chemotherapy/radiation and medical supportive care allows older patients to better tolerate treatment. This type of transplant is referred to as a nonmyeloablative SCT.
• In addition, patients who do not have a genetically-matched sibling or an unrelated donor available can benefit from a treatment approach utilizing cord blood from unrelated donors as a source for stem cells. Cord blood transplants were only offered to children in the past; however, recently conducted clinical trials have demonstrated the feasibility of using cord blood transplants as an option for adults.
• The post-transplant prognosis for patients has dramatically improved. This is due, in part, to better medical supportive care, including treatments for transplant-related side effects, such as graft-versus-host disease (GVHD) and infection. Moreover, the average hospitalization time for transplant has been substantially shortened.
• The development of new drugs, such as STI 571, also known as Gleevec, may make it possible for individuals with chronic myelogenous leukemia to avoid undergoing a transplant altogether. At the time of this writing, Gleevec is being tested to determine its effectiveness in treating a number of different diseases.

Despite all these reassuring and remarkable strides, the idea of a stem cell transplant is still overwhelming and understandably provokes anxiety for patients and their family members. SCT is a life-altering experience that requires a long-term commitment and is recommended for life-threatening conditions.

What you’ll find in these pages will help you understand and deal with the challenges of stem cell transplant. We have also addressed other important issues, such as insurance, finances, and preparing your family for the transplant. Information has been compiled by health professionals, survivors, and dedicated volunteers. Many have been where you are right now, trying to make sense of what lies ahead. We feel that this booklet will make transplant an easier experience for you and your family. We hope that if you have a clear overview of what your transplant entails, you’ll feel more in control and, with advanced planning, less overwhelmed.

Medical science has made great progress in the field of stem cell transplant. The vast majority of transplants treat diseases such as leukemia, lymphoma, multiple myeloma, and some solid tumor cancers. Today, people with immune deficiency disorders, sickle cell, or aplastic anemia may also benefit from transplant. In some individual cases, autoimmune disorders, such as multiple sclerosis, systemic lupus, and scleroderma are also being treated through transplant. So, while this procedure is not a simple solution, it does offer promise.

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