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.

Foundation for the Accreditation of Cellular TherapyOur autologous program is accredited by the internationally recognized Foundation for the Accreditation of Cellular Therapy (FACT).
 

  • Autologous – uses the patient’s own stem cells collected from blood or bone marrow
  • Umbilical cord – uses stem cells saved from the donor’s umbilical cord blood
  • Peripheral blood – uses stem cells from donor’s blood
  • Allogeneic – uses stem cells from a donor, either a relative or non-relative

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.

What is bone marrow?

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).

Why are bone marrow transplants (BMT) needed?

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:

  • Cancers (neuroblastoma, leukemia, lymphoma, brain tumors, or kidney cancer)
  • Immune deficiency and dysregulation (SCID, Severe Aplastic Anemia)
  • Genetic diseases (sickle cell, thalassemia)

What are the uses of autologous BMT?

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.

What is allogeneic BMT?

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.

How is the patient prepared to receive BMT?  

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.

How is BMT performed?

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.

What are the main complications of BMT?

  • Infections -  BMT recipients are at a very high risk of infections from the environment and bacteria, fungus and viruses that are present in their bodies. Patients are closely monitored for infections until one year after their BMT when infection risk decreases.
  • Graft Versus Host Disease (GVHD) - When a new immune system from a donor attacks the recipient, it’s called GVHD. Severe GVHD can be fatal and requires close monitoring and prompt treatment. Most patients will recover from immediate side effects of the preparative regimen within two months from BMT. There are long-term side effects from BMT that require life-long monitoring by specialists.

What is Cellular Therapy?

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.

Bone and Marrow Transplant Team

Arkansas Children’s has an experienced team that works with patients and families to provide the highest level of care.

Nurse Practitioners

  • Candace Mayle PNP
  • Leslie Humiston PNP

Patient and Donor Coordinators

  • Traci Hackler RN
  • Keri Hamm RN

Social Worker

  • Mary Mannion SW

Patient Educators

  • Laura Booth

Pharmacist

  • Hollye C Jackson Pharm D

Dietician

  • Rachel Tyler RD

Child-life Specialists

  • Haley Reeves
  • Ann Rocchi

Administrator and Nursing Supervisors

  • Amy Allen
  • Monica Russell
  • Sara Neal
  • Kathleen Lee

Apheresis Nurses

  • Zelenda Owens RN
  • Tammy Mobley RN
  • Sandra Smith RN
  • Loretta DePalo RN