My 6th Chemotherapy gets over on Saturday April 22, 17. After that PET SCAN would be carried out on May 1, 17 and compared with the previous one taken after the end of 3rd Chemotherapy.

I may consider STEM CELL TRANSPLANT hence a detailed study is carried out below for your knowledge well being.

The facility is available at Methodist hospital at Medical Center where in short 5-6 self injections will be carried out to generate stem cells at home. After one week I will go to hospital to give away extra generated stem cells which will / can be frozen preserved for 20 years. Then I need to be in the hospital for 3 weeks. High dose of Chemotherapy will be provided for 1 week and I will be kept under strict supervision for next 2 weeks to prevent any kind of infection. The cost of entire treatment is about $150,000 covered by insurance.

Lymphoma Research Foundation’s Mission:

To Eradicate This Disease

Support Innovative Lymphoma Research

The Lymphoma Research Foundation (LRF) remains dedicated to finding a cure for lymphoma through an aggressively-funded research program. LRF supports innovative research through Clinical Investigator Career Development Awards, Fellowships and several disease-specific research initiatives. These focused initiatives include: the Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma Initiative; the Diffuse Large B-Cell Lymphoma Program; the Follicular Lymphoma Initiative; and the Mantle Cell Lymphoma Initiative and Consortium.

Through its research program LRF aims to:

create therapies and discover cures to help patients now;
advance our understanding of lymphoma, laying the foundation for improved patient care;
attract and train new investigators and clinicians in lymphoma, ensuring a continuing stream of innovative and forward thinking researchers and clinicians; and
bring fresh ideas, energy and collaboration to the challenging field of lymphoma research.

Since 1992, LRF has made major contributions to the lymphoma research enterprise, awarding more than 300 research grants totaling $56 million. The Foundation’s volunteer Scientific Advisory Board (SAB), comprised of 45 world-renowned lymphoma experts, guides the Foundation’s research activities, seeking out the most innovative and promising lymphoma research projects for support.

Resources for Researchers and Healthcare Professionals

Physicians and researchers can find a variety of useful links here leading to resources, forms and information below.

Patient and Professional Education Programs

The Lymphoma Research Foundation (LRF) produces a variety of education programs for both patients and professionals. LRF’s patient education programs, including our Ask The Doctor series and annual North American Educational Forum on Lymphoma, provides your patients with in-person education to better understand their disease, treatment options, and more. Our Professional Education programs, Lymphoma Rounds (for physicians) and Caring for the Lymphoma Patient (for nurses), are designed to increase the knowledge, skills and performance of healthcare professionals and to maximize the quality of care for lymphoma patients.

ATCC MCL Cell Bank

The LRF Mantle Cell Lymphoma Cell Bank was created with the ATCC, The Global Bioresource Center, as an essential reserve for investigators to provide well characterized cell lines. To learn more about the MCL Cell Bank or to purchase cell lines, go to the ATCC website . Or go to www.atcc.org and use the Search box, type in “Mantle Cell Lymphoma” and choose Mantle Cell Lymphoma from the top of the results listing to see 8 cell lines collected by the Lymphoma Research Foundation and now housed and managed through ATCC.

Resources for Researchers

The LRF Mantle Cell Lymphoma Cell Bank was created with the ATCC, The Global Bioresource Center, as an essential reserve for investigators to provide well characterized cell lines. To visit ATCC.

STC – STEM CELL TRANSPLANT, IN LYMPHOMA CANCER

Stem-cell therapy is the use of stem cells to treat or prevent a disease or condition.

Bone marrow transplant is the most widely used stem-cell therapy, but some therapies derived from umbilical cord blood are also in use. Research is underway to develop various sources for stem cells, and to apply stem-cell treatments for neurodegenerative diseases and conditions such as diabetes, heart disease, and other conditions.

Stem-cell therapy has become controversial following developments such as the ability of scientists to isolate and culture embryonic stem cells, to create stem cells using somatic cell nuclear transfer and their use of techniques to create induced pluripotent stem cells. This controversy is often related to abortion politics and to human cloning. Additionally, efforts to market treatments based on transplant of stored umbilical cord blood have been controversial.

 

For over 30 years, bone marrow has been used to treat cancer patients with conditions such as leukaemia and lymphoma; this is the only form of stem-cell therapy that is widely practiced. During chemotherapy, most growing cells are killed by the cytotoxic agents. These agents, however, cannot discriminate between the leukaemia or neoplastic cells, and the hematopoietic stem cells within the bone marrow. It is this side effect of conventional chemotherapy strategies that the stem-cell transplant attempts to reverse; a donor’s healthy bone marrow reintroduces functional stem cells to replace the cells lost in the host’s body during treatment. The transplanted cells also generate an immune response that helps to kill off the cancer cells; this process can go too far, however, leading to graft vs host disease, the most serious side effect of this treatment.

Another stem-cell therapy called Prochymal, was conditionally approved in Canada in 2012 for the management of acute graft-vs-host disease in children who are unresponsive to steroids. It is an allogenic stem therapy based on mesenchymal stem cells (MSCs) derived from the bone marrow of adult donors. MSCs are purified from the marrow, cultured and packaged, with up to 10,000 doses derived from a single donor. The doses are stored frozen until needed.

The FDA has approved five hematopoietic stem-cell products derived from umbilical cord blood, for the treatment of blood and immunological diseases.

In 2014, the European Medicines Agency recommended approval of Holoclar, a treatment involving stem cells, for use in the European Union. Holoclar is used for people with severe limbal stem cell deficiency due to burns in the eye.

Research – Stem cells are being studied for a number of reasons. The molecules and exosomes released from stem cells are also being studied in an effort to make medications

Neurodegeneration

Research has been conducted on the effects of stem cells on animal models of brain degeneration, such as in Parkinson’s, Amyotrophic lateral sclerosis, and Alzheimer’s disease. There have been preliminary studies related to multiple sclerosis.

Brain and spinal cord injury

Stroke and traumatic brain injury lead to cell death, characterized by a loss of neurons and oligodendrocytes within the brain. A small clinical trial was underway in Scotland in 2013, in which stem cells were injected into the brains of stroke patients.

Heart

The pioneering work by Bodo-Eckehard Strauer has now been discredited by the identification of hundreds of factual contradictions. Among several clinical trials that have reported that adult stem-cell therapy is safe and effective, powerful effects have been reported from only a few laboratories, but this has covered old and recent infarcts as well as heart failure not arising from myocardial infarction.

Blood-cell formation

The specificity of the human immune-cell repertoire is what allows the human body to defend itself from rapidly adapting antigens. However, the immune system is vulnerable to degradation upon the pathogenesis of disease, and because of the critical role that it plays in overall defense, its degradation is often fatal to the organism as a whole. Diseases of hematopoietic cells are diagnosed and classified via a subspecialty of pathology known as hematopathology.

Regrowing teeth

In 2004, scientists at King’s College London discovered a way to cultivate a complete tooth in mice and were able to grow bioengineered teeth stand-alone in the laboratory. Researchers are confident that the tooth regeneration technology can be used to grow live teeth in human patients.

Cochlear hair cell regrowth

Heller has reported success in re-growing cochlea hair cells with the use of embryonic stem cells.

Blindness and vision impairment

Since 2003, researchers have successfully transplanted corneal stem cells into damaged eyes to restore vision. “Sheets of retinal cells used by the team are harvested from aborted fetuses, which some people find objectionable.” When these sheets are transplanted over the damaged cornea, the stem cells stimulate renewed repair, eventually restore vision.

Pancreatic beta cells

Diabetes patients lose the function of insulin-producing beta cells within the pancreas. In recent experiments, scientists have been able to coax embryonic stem cell to turn into beta cells in the lab. In theory if the beta cell is transplanted successfully, they will be able to replace malfunctioning ones in a diabetic patient.

Transplantation

Human embryonic stem cells may be grown in cell culture and stimulated to form insulin-producing cells that can be transplanted into the patient.

However, clinical success is highly dependent on the development of the following procedures:

• Transplanted cells should proliferate
  Transplanted cells should differentiate in a site-specific manner
  Transplanted cells should survive in the recipient (prevention of transplant rejection)
  Transplanted cells should integrate within the targeted tissue
  Transplanted cells should integrate into the host circuitry and restore function
  Orthopaedics
  Clinical case reports in the treatment orthopaedic conditions have been reported. To date, the focus in the literature for musculoskeletal care appears to be on mesenchymal stem cells. Centeno et al. have published MRI evidence of increased cartilage and meniscus volume in individual human subjects. The results of trials that include a large number of subjects, are yet to be published. However, a published safety study conducted in a group of 227 patients over a 3-4-year period shows adequate safety and minimal complications associated with mesenchymal cell transplantation.
• Wakitani has also published a small case series of nine defects in five knees involving surgical transplantation of mesenchymal stem cells with coverage of the treated chondral defects.

Wound healing

Stem cells can also be used to stimulate the growth of human tissues. In an adult, wounded tissue is most often replaced by scar tissue, which is characterized in the skin by disorganized collagen structure, loss of hair follicles and irregular vascular structure. In the case of wounded fetal tissue, however, wounded tissue is replaced with normal tissue through the activity of stem cells. A possible method for tissue regeneration in adults is to place adult stem cell “seeds” inside a tissue bed “soil” in a wound bed and allow the stem cells to stimulate differentiation in the tissue bed cells. This method elicits a regenerative response more similar to fetal wound-healing than adult scar tissue formation. Researchers are still investigating different aspects of the “soil” tissue that are conducive to regeneration.

Infertility

Culture of human embryonic stem cells in mitotically inactivated porcine ovarian fibroblasts (POF) causes differentiation into germ cells (precursor cells of oocytes and spermatozoa), as evidenced by gene expression analysis.

Human embryonic stem cells have been stimulated to form Spermatozoon-like cells, yet still slightly damaged or malformed. It could potentially treat azoospermia.

In 2012, oogonial stem cells were isolated from adult mouse and human ovaries and demonstrated to be capable of forming mature oocytes.These cells have the potential to treat infertility.

HIV/AIDS

Destruction of the immune system by the HIV is driven by the loss of CD4+ T cells in the peripheral blood and lymphoid tissues. Viral entry into CD4+ cells is mediated by the interaction with a cellular chemokine receptor, the most common of which are CCR5 and CXCR4. Because subsequent viral replication requires cellular gene expression processes, activated CD4+ cells are the primary targets of productive HIV infection. Recently scientists have been investigating an alternative approach to treating HIV-1/AIDS, based on the creation of a disease-resistant immune system through transplantation of autologous, gene-modified (HIV-1-resistant) hematopoietic stem and progenitor cells (GM-HSPC).

Clinical trials – Further information: Human embryonic stem cells clinical trials

GRNOPC1

On 23 January 2009, the US Food and Drug Administration gave clearance to Geron Corporation for the initiation of the first clinical trial of an embryonic stem-cell-based therapy on humans. The trial aimed evaluate the drug GRNOPC1, embryonic stem cell-derived oligodendrocyte progenitor cells, on patients with acute spinal cord injury. The trial was discontinued in November 2011 so that the company could focus on therapies in the “current environment of capital scarcity and uncertain economic conditions”. In 2013 biotechnology and regenerative medicine company BioTime (NYSE MKT: BTX) acquired Geron’s stem cell assets in a stock transaction, with the aim of restarting the clinical trial.

Cryopreserved mesenchymal stromal cells (MSCs)

Scientists have reported that MSCs when transfused immediately within few hours post thawing may show reduced function or show decreased efficacy in treating diseases as compared to those MSCs which are in log phase of cell growth(fresh), so cryopreserved MSCs should be brought back into log phase of cell growth in invitro culture before these are administered for clinical trials or experimental therapies, re-culturing of MSCs will help in recovering from the shock the cells get during freezing and thawing. Various clinical trials on MSCs have failed which used cryopreserved product immediately post thaw as compared to those clinical trials which used fresh MSCs.

Discover the healing power of your own stem cells

STC is the latest advancement in medical technology is the premier provider of regenerative medicine and stem cell therapy in the United States, and our services ensure that the disease-defying and revitalizing properties of your stem cells are available to you whenever you need them.

What is a Stem Cell Transplant (Bone Marrow Transplant)?

A stem cell transplant is a treatment for some types of cancer. For example, you might have one if you have leukemia, multiple myeloma, or some types of lymphoma. Doctors also treat some blood diseases with stem cell transplants.

In the past, patients who needed a stem cell transplant received a “bone marrow transplant” because the stem cells were collected from the bone marrow. Today, stem cells are usually collected from the blood, instead of the bone marrow. For this reason, they are now more commonly called stem cell transplants.

Why are bone marrow and stem cells important?

A part of your bones called “bone marrow” makes blood cells. Marrow is the soft, spongy tissue inside bones. It contains cells called “hematopoietic” stem cells (pronounced he-mah-tuh-poy-ET-ick). These cells can turn into several other types of cells. They can turn into more bone marrow cells. Or they can turn into any type of blood cell.

Certain cancers and other diseases keep hematopoietic stem cells from developing normally. If they are not normal, neither are the blood cells that they make. A stem cell transplant gives you new stem cells. The new stem cells can make new, healthy blood cells.

Types of STC – Stem Cell Transplant

The main types of stem cell transplants and other options are discussed below.

• Autologous transplant. Doctors call this an AUTO transplant. This type of stem cell transplant may also be called high-dose chemotherapy with autologous stem cell rescue.In an AUTO transplant, you get your own stem cells after doctors treat the cancer. First, your health care team collects stem cells from your blood and freezes them. Next, you have powerful chemotherapy, and rarely, radiation therapy. Then, your health care team thaws your frozen stem cells. They put them back in your blood through a tube placed in a vein (IV).It takes about 24 hours for your stem cells to reach the bone marrow. Then they start to grow, multiply, and help the marrow make healthy blood cells again.
• Allogeneic transplantation. Doctors call this an ALLO transplant.In an ALLO transplant, you get another person’s stem cells. It is important to find someone whose bone marrow matches yours. This is because you have certain proteins on your white blood cells called human leukocyte antigens (HLA). The best donor has HLA proteins as much like yours as possible.Matching proteins make a serious condition called graft-versus-host disease (GVHD) less likely. In GVHD, healthy cells from the transplant attack your cells. A brother or sister may be the best match. But another family member or volunteer might work.Once you find a donor, you receive chemotherapy with or without radiation therapy. Next, you get the other person’s stem cells through a tube placed in a vein (IV). The cells in an ALLO transplant are not typically frozen. So, doctors can give you the cells as soon after chemotherapy or radiation therapy as possible.There are 2 types of ALLO transplants. The best type for each patient depends his or her age and health and the type of disease being treated.
  • Ablative, which uses high-dose chemotherapy
  • Reduced intensity, which uses milder doses of chemotherapy

If your health care team cannot find a matched adult donor, there are other options. Research is ongoing to determine which type of transplant will work best for different patients.

• Umbilical cord blood transplant. This may be an option if you cannot find a donor match. Cancer centers around the world use cord blood.
• Parent-child transplant and haplotype mismatched transplant. These types of transplants are being used more commonly. The match is 50%, instead of near 100%. Your donor might be a parent, child, brother, or sister.

Choosing a transplant

Your doctor will recommend an AUTO or ALLO transplant based mostly on the disease you have. Other factors include the health of your bone marrow and your age and general health. For example, if you have cancer or other disease in your bone marrow, you will probably have an ALLO transplant. In this situation, doctors do not recommend using your own stem cells.

Choosing a transplant is complicated. You will need help from a doctor who specializes in transplants. So you might need to travel to a center that does many stem cell transplants. Your donor might need to go, too. At the center, you talk with a transplant specialist and have an examination and tests. Before a transplant, you should also think about non-medical factors. These include:

• Who can care for you during treatment
• How long you will be away from work and family responsibilities
• If your insurance pays for the transplant
• Who can take you to transplant appointments

Your health care team can help you find answers to these questions.

 

How a transplant works

The information below tells you the main parts of AUTO and ALLO transplants. Your health care team usually does the steps in order. But sometimes certain steps happen in advance, such as collecting stem cells. Ask your doctor what to expect before, during, and after a transplant.

AUTO transplant timeline

Part 1: Collecting your stem cells

• A doctor puts a thin tube called a “transplant catheter” in a large vein. The tube stays in until after the transplant. Your health care team will collect stem cells through this tube and give chemotherapy and other medications through the tube.
• You get injections of a medication to raise your number of white blood cells. White blood cells help your body fight infections.
• Your health care team collects stem cells, usually from your blood.

Time: 1 to 2 weeks

Where it’s done: Clinic or hospital building. You do not need to stay in the hospital overnight.

Part 2: Transplant treatment

• You get high doses of chemotherapy, and rarely, radiation therapy.

Time: 5 to 10 days

Where it’s done: Clinic or hospital. At many transplant centers, patients need to stay in the hospital for the duration of the transplant, usually about 3 weeks. At some centers, patients receive treatment in the clinic and can come in every day.

Part 3: Getting your stem cells back

• Doctors call this the “stem cell transfusion.” Your health care team puts your stem cells back in your blood through the transplant catheter.

Time: Each infusion usually takes less than 30 minutes. You may receive more than 1 infusion.

Where it’s done: Clinic or hospital.

Part 4: Recovery

• You take antibiotics and other drugs. You get blood transfusions through your transplant catheter if needed. Your health care team helps with any transplant side effects.

Time: approximately 2 weeks

Where it’s done: Clinic or hospital. You might be staying in the hospital or you might not.

ALLO transplant timeline

My Oncologist has suggested to go with Methodist Hospital which is just next building and specialized in STC, under Baylor College of Medicine.

Cost: It costs about $150,000 – $160,000. Since I have already maxed out Out-of-Pocket insurance premium of $7,500 through my insurance company Community Health Choice (the one under Obama Care) for 2017, I will not have to pay anything and entire cost will be covered by Insurance Company.

First step – The process is that the hospital gives 5 doses of injections that I will have to be self-inject into the subcutaneous layer of the skin. It will be done at home and there is no need to go to the hospital. Suppose, your body generally has 10,000 stc. This injection will boost the cells to 140,000 stc, then extra 40,000 stc can safely be removed from the body.

Part 1: Collecting stem cells from your own body or outside donor

• The health care team gives your donor injections of a medication to increase white cells in the blood, if the cells are collected from blood. Some donors will donate bone marrow in the operating room during a procedure which takes several hours.

Time: Varies based on how the stem cells are collected

Where it’s done: Clinic or hospital

Part 2: Transplant treatment

• You get chemotherapy of very high dosage say 20 times more powerful than what I am getting now. But there is a medicine to back up for each and every vital organ of the body, lest they fail. For example chemo medicine to protect kidney, heart, liver and so on. The patient has to be in the hospital for minimum 3 weeks, and a team of doctors monitor the situation very closely to protect from every infection as all cells in the body are DEAD good or bad, as if new born baby. There is chance of 2-3% patients dying during this period if not taken care of well. Once cells are frozen and preserved they can be kept healthy for 20 years and transplant can be done anytime. But the best results are immediately after the chemotherapy.

Time: 5 to 7 days for chemotherapy

Time in watch period in the hospital: 3 weeks

Where it’s done: Many ALLO transplants are done in the hospital.

Part 3: Getting back treated cells or from the donor cells

• Doctors call this the “stem cell transfusion.” Your health care team puts the donor’s stem cells in your blood through the transplant catheter. It takes less than 1 hour. The transplant catheter stays in until after treatment.

Time: 1 day

Where it’s done: Clinic or hospital.

Part 4: Recovery period like normal person is about 2 months

• You take antibiotics and other drugs. This includes medications to prevent graft-versus-host disease. You get blood transfusions through your catheter if needed. Your health care team takes care of any side effects from the transplant.
• After the transplant, patients visit the clinic frequently at first and less often over time.

Time: Varies

• For an ablative transplant, patients are usually in the hospital for about 4 weeks in total.
• For a reduced intensity transplant, patients are in the hospital or visit the clinic daily for about 1 week.

 

Why Bank Now as frozen preserved ?

Milestones of successful Transplant

The words “successful transplant” might mean different things to you, your family, and your doctor. Below are 2 ways to measure transplant success.

Your blood counts are back to safe levels. A “blood count” is the number of red cells, white cells, and platelets in your blood. A transplant makes these numbers very low for 1 to 2 weeks. This causes risks of:

• Infection from low numbers of white cells, which fight infections
• Bleeding from low numbers of platelets, which stop bleeding
• Tiredness from low numbers of red cells, which carry oxygen

Doctors lower these risks by giving blood and platelet transfusions after a transplant. You also take antibiotics to help prevent infections. When the new stem cells multiply, they make more blood cells. Then your blood counts improve. This is one way to know if a transplant is a success.

It controls your cancer. Doctors do stem cell transplants with the goal of curing disease. A cure may be possible for some cancers, such as some types of leukemia and lymphoma. For other patients, remission is the best result. Remission is having no signs or symptoms of cancer. After a transplant, you need to see your doctor and have tests to watch for any signs of cancer or complications from the transplant.

BONE MARROW TRANSPLANT / CELL AND GENE THERAPY

Houston Methodist Hospital, in conjunction with Baylor College of Medicine and Texas Children’s Hospital, has established the Center for Cell and Gene Therapy to apply innovative and cost-effective cellular and genetic treatment options to our cancer patients.This is where I might get treated

Bone Marrow and Peripheral Blood Hematopoietic Stem Cell Transplantation

Although stem cells are now being explored for the treatment of many diseases and conditions, one of the first clinical applications for stem cell therapy was in the treatment of cancer. Blood-forming (hematopoietic) stem cells in bone marrow are quite sensitive to the effects of chemotherapy and radiation and the loss of those essential cells may be a factor that limits the amount of chemotherapy or radiation you are able to tolerate. Stem cells (originally obtained only from bone marrow, but now also prepared from the peripheral blood) make it possible to use higher doses of radiation or chemotherapy to kill cancer cells. You receive stem cells that will repopulate your bone marrow. Following this transplant you are at risk of infection until the donor marrow has engrafted (taken hold). Largely due to this risk of infection, you will be kept in carefully controlled hospital settings, equipped with infection-fighting features such as the advanced air-filtration systems. Stem cell transplantation is a very active area of research, and you may be considered for a clinical trial in this area.

Cell and Gene Therapy

It is a top priority at Houston Methodist to make potentially life-saving treatments available to patients as soon as possible. Your doctors may discuss cell and gene therapy as a potential way to treat your tumor:

• How Cell and Gene Therapy Works
• What to Expect From Cell and Gene Therapy
• Side Effects and Risks of Cell and Gene Therapy
• After Cell and Gene Therapy

How Cell and Gene Therapy Works

Your genes are the parts of your cells that contain DNA, the “code” that determines your body’s form and function. Researchers have found that certain genetic defects can cause a variety of diseases, including cancer.

Cell and gene therapy as a cancer treatment can work in many different ways:

• Changing the genes that control your normal immune cells so that they are better able to recognize and kill the cancer
• Engineering immune cells to recognize specific viruses in order to restore patient immune systems after bone marrow and cell transplantation
• Blocking dangerous pathways or otherwise inhibiting cancer growth using small molecule inhibitors or monoclonal antibodies

Because a gene cannot be inserted directly into a cell, it must be delivered using a carrier, also called a vector. The most commonly used vectors in cell and gene therapy are viruses, which have a unique ability to recognize certain cells and insert genetic material into them.

The two general approaches in introducing vectors into the body to deliver genetic content include:

• In ex vivo genetic therapy, cells are taken from your blood or bone marrow and introduced to the vector carrying the desired gene in the laboratory. The cells are grown in a culture in the lab and then reintroduced into your body.
• In in vivo genetic therapy, vectors (usually viruses) containing the desired gene are injected directly into your body.

What to Expect From Cell and Gene Therapy
Your specific treatment will depend on the type of cancer you have and the type of cell and gene therapy being used. Your doctor will discuss any relevant protocols with you, including potential risks and benefits. As all current cell and gene therapies are investigational, you will receive a consent form that includes a detailed explanation of the therapy.

Side Effects and Risks of Cell and Gene Therapy
Because cell and gene therapy is still in the experimental stage, there may be risks that have not yet been discovered; certain risks are possible, especially when viruses are used as carriers for the genetic material. Your doctor will discuss the potential risks of the therapy with you, and any possible side effects will also be outlined in detail on the consent form you receive.

After Cell and Gene Therapy
As with any cancer treatment, it is important to pay close attention to the instructions from your doctor and know which warning signs to watch out for in the days and months following your procedure.

Other Cancer Treatment Options
Learn more about other treatment options, such as chemotherapy, radiation therapy, or surgery. You can also learn more about the unique screening, diagnosis, and treatment for different kinds of cancer.

At Houston Methodist, we are dedicated to research and committed to a goal of making a clinical trial available to every patient who has a medical need and wants to participate. Learn more about our current cancer-related clinical trials.

CENTER FOR CELL & GENE THERAPY

Houston Methodist Hospital is dedicated to exploring the origins of disease, developing novel therapeutic treatments, and applying them in clinical practice for the benefit of adults and children.

• To facilitate and support collaboration among experts in all areas of human disease so that cellular and genetic therapies may be used as safely and as rapidly as possible.
• To ensure that cell and gene therapy patients have continued access to the latest and most effective cellular and genetic treatments available.

• An adult unit designed specifically for the specialized care of immune-compromised patients, including the use of an advanced air filtration system
• Pediatric and adult bone marrow and stem cell transplant units, in collaboration with leading institutions
• A family care setting in the Adult Stem Cell Transplant unit, which includes an activity center, computer business center and entertainment/dining area

In addition to adult and pediatric clinical units, the center contains laboratory space to support a wide array of basic and translational research. Areas of scientific collaboration with leading institutions include:

• Identification of genes and cells involved in disease initiation and progression
• Development of models for the study, design and mass production of vectors, which deliver cells to their targets in the body
• Bone marrow and stem cell transplant research
• Development of products to improve immune reconstitution after bone marrow and stem cell transplantation
• Development of safe, efficient and standardized methods for preparing patient and donor specimens for use in transplantation and cell and gene therapy
• Flow cytometry core laboratories featuring technology that sorts and analyzes cells, resulting in increased diagnostic capabilities and more targeted treatments

It is a top priority at Houston Methodist to make potentially life-saving treatments available to patients as soon as possible.

Blood Cancer

Blood or marrow stem cell transplants are performed for individuals who have diseased marrow or who will be receiving high doses of cancer therapy which will damage the marrow. Among the most common types of blood cancers treated with a transplant are lymphoma, myeloma and leukemias.

Stem Cell Transplant Program

The Adult Blood Cancer and Stem Cell Transplant Program at Texas Transplant Institute, a department ofMethodist Hospital, is one of the most preferred programs in the United States. Our program completes over 200 blood or marrow stem cell transplants each year. The medical team has completed over 2,400 blood or marrow stem cell transplants, or BMTs, since the program’s inception in 1993.

Certified by the national marrow donor program, our program ranks in the top 20% in the nation in volumes from allogeneic transplants. The program consistently ranks among the nation’s top transplant centers in one-year allogeneic stem cell transplant patient survival rates among all transplant centers in Texas (Source: 2013 CIMBTR Transplant Specific Survival Rates) and is a member of the Sarah Cannon Blood Cancer Research Network. Our Blood Cancer and Stem Cell Transplant Programs are committed to bringing you new and innovative investigational treatment options.

Our clinics offer full service for bone marrow biopsies, chemotherapy infusions, transfusion, stem cell transplant evaluations and infusions and other procedures.

If the putative cancer stem cells are less sensitive to these therapies, then they will remain viable after therapy and re-establish the tumor. By contrast, if therapies can be targeted against cancer stem cells, then they might more effectively kill the cancer stem cells, rendering the tumors unable to maintain themselves or grow. Thus, even if cancer stem cell-directed therapies do not shrink tumors initially, they may eventually lead to cures.

High-Dose Chemotherapy and Stem Cell Transplant for Non-Hodgkin Lymphoma

A stem cell transplant (also known as a bone marrow transplant) lets doctors give higher doses of chemotherapy, sometimes along with radiation therapy.

The doses of chemotherapy drugs are normally limited by the side effects these drugs can cause. Higher doses can’t be used, even if they might kill more cancer cells, because they would severely damage the bone marrow, where new blood cells are made.

But with a stem cell transplant, doctors can give high doses of chemo because the patient receives a transplant of blood-forming stem cells to restore the bone marrow afterwards.

Stem cell transplants are sometimes used to treat lymphoma patients who are in remission or who have a relapse during or after treatment. Although only a small number of people with lymphoma are treated with this therapy, this number is growing.

Types of stem cell transplants

There are 2 main types of stem cell transplants (SCTs) based on where the stem cells come from.

• In an autologous stem cell transplant, the patient’s own stem cells are used. They are collected several times in the weeks before treatment. The cells are frozen and stored while the person gets treatment (high-dose chemo and/or radiation) and then are given back into the patient’s blood by an IV.
• In an allogeneic stem cell transplant, the stem cells come from someone else (a donor). Usually this is a brother or sister, although the source may be an unrelated donor or umbilical cord blood. The donor’s tissue type (also known as the HLA type) needs to match the patient’s tissue type as closely as possible to help prevent the risk of major problems with the transplant. Regardless of the source, the stem cells are frozen and stored until they are needed for the transplant.

Autologous SCTs are used more often than allogeneic SCTs to treat lymphoma. Still, using the patient’s own cells may not be an option if the lymphoma has spread to the bone marrow or blood. If that happens, it may be hard to get a stem cell sample that is free of lymphoma cells.

Allogeneic transplants are used less often for lymphoma because they can have severe side effects that make them hard to tolerate, especially for patients who are older or who have other medical problems. It can also be hard to find a matched donor.

A stem cell transplant is a complex treatment that can cause life-threatening side effects. If the doctors think a person might benefit from a transplant, it should be done at a cancer center where the staff has experience with the procedure and with managing the recovery phase.

During your bone marrow transplant

Your bone marrow transplant occurs after you complete the conditioning process. On the day of your transplant, called day zero, stem cells are infused into your body through your central line.

The transplant infusion is painless. You are awake during the procedure.

The transplanted stem cells make their way to your bone marrow, where they begin creating new blood cells. It can take a few weeks for new blood cells to be produced and for your blood counts to begin recovering.

Bone marrow or blood stem cells that have been frozen and thawed contain a preservative that protects the cells. Just before the transplant, you may receive medications to reduce the side effects the preservative may cause. You’ll also likely be given IV fluids (hydration) before and after your transplant to help rid your body of the preservative.

Side effects of the preservative may include:

• Headache
• Nausea
• Shortness of breath
• A strange taste in your mouth as the preservative is infused

Not everyone experiences side effects from the preservative, and for some people those side effects are minimal.

After your bone marrow transplant

When the new stem cells enter your body, they begin to travel through your body and to your bone marrow. In time, they multiply and begin to make new, healthy blood cells. This is called engraftment. It usually takes several weeks before the number of blood cells in your body starts to return to normal. In some people, it may take longer.

In the days and weeks after your bone marrow transplant, you’ll have blood tests and other tests to monitor your condition. You may need medicine to manage complications, such as nausea and diarrhea.

After your bone marrow transplant, you’ll remain under close medical care. If you’re experiencing infections or other complications, you may need to stay in the hospital for several days or sometimes longer. Depending on the type of transplant and the risk of complications, you’ll need to remain near the hospital for several weeks to months to allow close monitoring.

You may also need periodic transfusions of red blood cells and platelets until your bone marrow begins producing enough of those cells on its own.

You may be at greater risk of infections or other complications for months to years after your transplant.

Stem cell transplantation for non-Hodgkin lymphoma

Before a stem cell transplant for non-Hodgkin lymphoma, you will undergo a conditioning regimen, which involves intensive treatment, such as high-dose chemotherapy, to destroy as many cancer cells as possible. Following this preparative regime, you will receive the stem cells intravenously (similar to a blood transfusion). The procedure takes about an hour. After entering the bloodstream, the stem cells travel to the bone marrow and begin to produce healthy new blood cells in a process known as engraftment.

Sometimes, the high doses of chemotherapy or radiation you receive before the stem cell transplant causes side effects, such as infection. An allogeneic stem cell transplant poses the risk of graft-versus-host-disease (GVHD), a condition where the donated cells attack the patient’s tissues. Your doctor may prescribe certain drugs to reduce the risk of infection or GVHD.

Helping you manage side effects after a transplant

Recovery from stem cell transplantation can take several months. You’ll need support from multiple areas to help you manage side effects and maintain your quality of life.

The following are examples of how your care team will support you during this time:

• Your nutritionist will develop a personalized meal plan to fortify your body after the transplant.
• Your naturopathic clinician will recommend natural therapies to help minimize side effects like peripheral neuropathy and fatigue.
• Your pain management practitioner will use pain management methods to help control pain and alleviate discomfort.
• Your mind-body therapist will provide counseling and stress management techniques to help you relax.
• Your rehabilitation therapist will create an individual exercise program to help you stay active and independent.
• Your spiritual counselor will help nurture your spiritual well-being.

Ssignificant improved survival rates for stem cell transplant recipients

The study analyzed outcomes for more than 38,000 transplant patients with life-threatening blood cancers and other diseases over a 12-year period — capturing approximately 70 to 90 percent of all related and unrelated blood stem cell transplants performed in the U.S. It was led by Theresa Hahn, Ph.D., of Roswell Park Cancer Institute (RPCI), in collaboration with the Center for International Blood and Marrow Transplant Research® (CIBMTR), the research arm of the National Marrow Donor Program® (NMDP) and Be The Match®.

“This study shows that we are making significant progress, on a national level, in survival after transplantation. Patients across the country have benefited from the collaborative efforts of the CIBMTR, the NMDP and clinical researchers at individual transplant centers,” said Dr. Hahn, an Associate Member and Associate Professor of Oncology in RPCI’s Department of Medicine and first author on the study. “Our results demonstrate that these efforts have yielded improvement in early survival rates, and we will continue to work together to further improve long-term survival.”

At 100 days post-transplant, the study shows survival significantly improved for patients with myeloid leukemias (AML) receiving related transplants (85 percent to 94 percent) and unrelated transplants (63 percent to 86 percent). At one-year post-transplant, patients who received an unrelated transplant showed an increased survival rate from 48 to 63 percent, while the survival rate for related transplant recipients did not improve. Similar results were seen for patients with acute lymphoblastic leukemia (ALL) and myelodysplastic syndrome (MDS).

“The existence of the CIBMTR, which is a collaboration of the NMDP and the Medical College of Wisconsin, and its database of more than 330,000 patient outcomes made it possible for us to study whether and how the use of blood stem cell transplants, both related and unrelated, have changed over time,” said Navneet Majhail, M.D., co-author of the study and medical director at the NMDP. “The significant improvements we saw across all patient and disease populations should offer patients hope and, among physicians, reinforce the role of blood stem cell transplants as a curative option for life-threatening blood cancers and other diseases.”

In addition to improved survival, the authors note a significant increase in the overall number of patients receiving transplants. Related and unrelated transplant as treatment for ALL, AML, MDS and Hodgkin and non-Hodgkin lymphomas increased by 45 percent — from 2,520 to 3,668 patients annually. This is likely due to the use of reduced-intensity conditioning therapy and a greater availability of unrelated volunteer donors, a result of efforts by the NMDP and Be The Match to increase and diversify the Be The Match Registry®.