Arkansas Children’s Hospital offers both allogeneic autologous blood marrow transplants to treat cancers, immune disorders and blood diseases. BMT uses healthy bone marrow, or stem cells to replace damaged or destroyed bone marrow.
Our autologous program is accredited by the internationally recognized Foundation for the Accreditation of Cellular Therapy (FACT).
Our program is also a certified CAR-T site. Chimeric antigen receptor (CAR) T cells uses the patient’s own genetically modified T cells to attack and kill cancer cells. This therapy is used to treat some of the most challenging pediatric cancers including B-cell acute lymphoblastic leukemia (ALL). We are currently using CAR-T cells treatment known as tisagenlecleucel (Kymriah).
Questions and Answers by Dr. Arunkumar Modi, director of bone marrow transplant and cellular therapy at Arkansas Children’s.
Bone marrow is a liquid contained within the bones and responsible for the constant production of blood. There are primarily three types of blood cells; these include red cells (carrying oxygen), platelets (stop bleeding) and white cells (immune system).
A successful BMT corrects inherited (genetic) or acquired (diseases like cancer) diseases in any of the cells produced by the bone marrow. BMT is used for conditions such as:
Autologous BMT is typically for patients who require very high doses of chemotherapy or radiation to treat their cancer. One of the most dangerous side effects of high-dose chemotherapy is wiping out of bone marrow cells, making a patient high risk of dying from bleeding and infectious complications. A successful BMT will allow the patient to have blood cell recovery within 2-3 weeks compared to 8 weeks or more without it. Autologous BMT has only been used to treat chemotherapy-responsive cancer.
Allogeneic BMT is usually performed to replace the immune system to help correct the inherited defect in blood cells (sickle cell disease) or allow a new immune system to prevent blood cancer from coming back. When a person has blood cancer that is less likely to be cured by chemotherapy alone, BMT introduces a new immune system that prevents cancer from coming back. The most common reason for allogeneic BMT is blood cancer.
A preparative regimen is usually comprised of multiple agents of chemotherapy and/or radiation. The primary goals of the preparative regimen are to eliminate the recipient’s immune system and create space in the bone marrow. Preparative regimens are customized to the recipient’s condition.
After a patient has received a preparative regimen, bone marrow cells are infused into their blood like a simple blood transfusion. Most people are surprised at how simple the procedure is.
Cellular therapy is when a person’s immune system cells are modified in the lab to make them target a specific protein present on cancer cells or virus-infected cells. Chimeric Antigen Receptor T cell (CAR T cell) therapy against CD-19 positive blood cancer can recognize, attack, and kill pre-B cell leukemia that normally evades immune damage. This has been very successful in clinical trials and is now available at Arkansas Children’s Hospital. This is the most modern way to harness the power of the human immune system to kill cancer and virus-infected cells.
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