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 include leukemia, lymphoma and myeloma. Treatment for blood cancers has advanced dramatically over the years to 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 about treatment options. Dr. Bhagirathbhai Dholaria, an expert in hematologic oncology at the Vanderbilt Stem Cell Transplant and Cellular Therapy Clinic explains what stem cell transplants and CAR-T therapy entail.
Stem cell transplant for blood cancers
Stem cell transplants for blood cancers are hematopoietic cell transplants, meaning they use stem cells from the bone marrow cavity.
“Most of the stem cell collection is done through peripheral blood collection only,” Dholaria said. “So most donors don’t have to undergo bone marrow harvest.”
There are two types of hematopoietic cell transplants. An autologous transplant uses the patient’s own stem cells. And an allergenic transplant uses healthy donor stem cells. “These are two completely different types of procedures with a different recovery time and entirely different indications,” Dholaria explained.
Autologous stem cell transplant is a treatment for blood cancer used for patients with either newly diagnosed or a relapse of multiple myeloma. “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 eradicated with chemotherapy or when the cancer has returned after a prior blood cancer treatment option.
“Vanderbilt is one of the few centers in the country that offers ‘bloodless’ autologous stem cell transplant for patients who are Jehovah’s Witnesses,” Dholaria added.
Allergenic stem cell transplant is generally 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 syndrome.
A patient will receive chemotherapy first to eradicate the cancer in their body. Then they’ll 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,” he explained, “so that we can make them supercharged.” Then the patient receives an injection of the genetically modified T-cells, and the T-cells identify and destroy the cancer.
CAR-T is reserved for patients who have had a relapse after undergoing other forms of treatment for acute lymphoblastic leukemia, diffuse large B cell lymphoma (DLBCL), mantle cell lymphoma, follicular lymphoma or relapse multiple myeloma.
“We improve the fitness of the patients to build stamina and reduce the risk of complications. Then after the stem cell transplant, they go to rehab. It really helps with their overall well-being.”
Vanderbilt was the first center in Tennessee to offer CAR-T. And it was one of the few centers in the country to offer autologous and allergenic stem cell transplants as well as all types of CAR-T in the outpatient setting. However, Vanderbilt does have a dedicated inpatient unit should a patient need a form of inpatient care.
“This is one of the great things about coming to Vanderbilt,” Dholaria said. “Our outcomes are, in some cases, superior to other centers who put patients in the hospital for two to three weeks for stem cell transplant or CAR-T. They eat better, they sleep better, they move better when they are outpatient.”
Vanderbilt also has a post-transplant rehab center that also helps patients “prehab” before transplant or CAR-T. “We improve the fitness of the patients to build stamina and reduce the risk of complications,” Dholaria said. “Then after the stem cell transplant, as soon as it is safe, they go to rehab. It really helps with their overall well-being.”
Blood Cancer treatment at Vanderbilt
Blood cancers can have various and seemingly unrelated symptoms, such as unexplained fatigue and persistent infection. Vanderbilt Health’s specialized team works together to provide a precise diagnosis, second opinion consultations and the most effective treatment options, including innovative immunotherapy.