Understanding stem cell transplant and CAR-T therapy as treatment for blood cancers.
Some cancers are not solid like a tumor or mass and instead begin in lymph, blood or bone marrow.
These cancers are sometimes referred to as blood cancers. They include leukemia, lymphoma and myeloma. Treatment for blood cancers has improved dramatically in recent years. Today treatments include stem cell transplants and chimeric antigen receptor T-cell (CAR-T) therapy.
If you or a loved one has been diagnosed with a type of blood cancer, you may be wondering what treatment options are available. Here, Dr. Bhagirathbhai Dholaria, an expert in hematologic oncology (blood cancers) at the Vanderbilt Stem Cell Transplant and Cellular Therapy Clinic explains stem cell transplants and CAR-T therapy.
Stem cell transplant for blood cancers
Stem cell transplants for blood cancers are “hematopoietic” cell transplants. That means they use stem cells from bone marrow. Stem cells are found in many tissues throughout the body. They can grow to become different types of cells with different special functions.
“Most of the stem cell collection is done through peripheral blood collection only,” Dholaria said. That means taking a blood sample and looking at it under a microscope. “So most donors don’t have to undergo bone marrow harvest” – having a sample of marrow drawn from inside a bone.
There are two types of hematopoietic cell transplants. An autologous transplant uses the patient’s own stem cells. And an allogeneic transplant uses healthy stem cells donated by another person.
“These are two completely different types of procedures with a different recovery time and entirely different indications (reasons to use them),” Dholaria explained.
Autologous stem cell transplant is a treatment for blood cancer used for people with either newly diagnosed multiple myeloma, or a relapse of that type of cancer. “For multiple myeloma, it is one of the most effective forms of therapy in getting people into long-term durable remission,” Dholaria said.
Autologous stem cell transplant is also reserved for patients with different types of lymphoma whose cancer was not wiped out with chemotherapy. It is also used for these patients if their cancer has come back after a different treatment for blood cancer.
Allogeneic stem cell transplant is also reserved for more aggressive forms of blood cancer, Dholaria explained, such as acute myeloid leukemia, acute lymphoblastic leukemia or other types of bone marrow failure.
A patient will receive chemotherapy first to eradicate the cancer in their body. Then they will receive an intravenous injection of stem cells from a donor. Donors are found through an international donor registry. In some cases, family members may be able to donate. People no longer need to be a full match. “For the donor,” Dholaria said, “it’s like donating blood.”
Vanderbilt also offers stem cell transplant for various autoimmune disorders, such as systemic sclerosis and multiple sclerosis, Dholaria added.
CAR-T therapy for blood cancer treatment
T-cells are a type of immune cell that normally fight different types of infections and malignancies.
Chimeric antigen receptor T-cell (CAR-T) therapy is a treatment for blood cancers that involves collecting T-cells, either from the patient or from a healthy donor. “These T-cells are then genetically modified in the lab,” Dholaria explained, “so that we can make them ‘supercharged.’ ” The patient receives an injection of the genetically modified T-cells, which identify the cancer in their body and destroy it.
CAR-T is for patients who have had a relapse after undergoing other forms of treatment for acute lymphoblastic leukemia, diffuse large B cell lymphoma, mantle cell lymphoma, follicular lymphoma or relapsed multiple myeloma.
The best possible care for blood cancers
Vanderbilt-Ingram Cancer Center was the first center in Tennessee to offer CAR-T therapy. It was also among the few in the U.S. to perform stem cell transplants and CAR-T without a hospital stay. We also offer a rehab center to prepare patients ahead of treatment and help recovery afterward.
Vanderbilt is one of the few centers in the U.S. offering “bloodless” autologous stem cell transplant, important for some patients for religious reasons. This procedure requires a team of specialized experts to minimize complications.
