Stem Cell Transplant and Cellular Therapy Program

Also known as a bone marrow transplant, a stem cell transplant is used in cancer treatment to replace damaged or diseased bone marrow with healthy stem cells. Autologous transplants involve cells that have come from your own body. Allogeneic transplants involve cells that have come from related or unrelated donors. Both types are available in the Stem Cell Transplant and Cellular Therapy program.

Stem cell transplants are a treatment option for certain blood disorders and cancers, including:

• Acute lymphoblastic leukemia (ALL)
• Acute myeloid leukemia (AML)
• Hodgkin lymphoma
• Multiple myeloma
• Myelodysplastic syndrome (MDS)
• Myelofibrosis
• Non-Hodgkin lymphoma

If you need a stem cell transplant, you will undergo tests to evaluate your overall health, including lung, heart, kidney and liver function testing. An autologous stem cell transplant begins with medications to increase the number of stem cells in your blood. Then, your stem cells are collected and stored until it is time for your transplant.

For an allogeneic stem cell transplant, your care team will work to identify an appropriate donor, either among your relatives or through national programs such as the Marrow Donor Program (also known as Be the Match). This provides each patient with a large pool of potential tissue type-matched donors.

With either type of transplant, you’ll receive treatment that will destroy the diseased cells in your body. The healthy cells – either yours or the donor’s – are infused into your body through an IV. They will travel to the bone marrow to start repopulating your bloodstream with healthy blood cells.

Afterward, you’ll need to stay in the hospital for several weeks in a private room designed to protect you from germs. Your family will be able to visit and will receive options for staying nearby. Our entire team will work seamlessly to support you throughout your care journey, answering any questions you or your family members have and prioritizing your comfort alongside your treatment outcomes.

CAR-T treatment involves extracting T cells, which are those that defend the body against disease, from your blood. They are sent to a lab, where they are changed by adding a protein called chimeric antigen receptor (CAR). This protein acts like a navigation system that helps the T cells track down and kill cancer cells. These altered T cells – now called CAR-T cells – are multiplied in the lab and reinfused into your bloodstream.

Two lines of treatment from the Cancer Institute’s first pharmaceutical collaborator, Kite, are currently available for patients who are healthy enough to receive them and who meet the criteria:

TECARTUS® (brexucabtagene autoleucel) is for:

• Mantle cell lymphoma (MCL) in adult patients, when another treatment did not work, or the cancer returned after treatment
• B-cell acute lymphoblastic leukemia (ALL) in adult patients, when another treatment did not work, or the cancer returned after treatment

YESCARTA® (axicabtagene ciloleucel) is used to treat two types of non-Hodgkin lymphoma:

• Large B-cell lymphoma (LBCL) in adults who have tried one previous treatment that didn't work, or one previous treatment and had their cancer come back within 12 months, or two or more previous treatments that didn't work, or two or more previous treatments and had their cancer come back
• Follicular lymphoma (FL) in adults who have tried two or more previous treatments that didn't work, or two or more previous treatments and had their cancer come back.

Prior to receiving CAR-T therapy, you will undergo a complete workup. The staff assesses lung, heart and other organ functions to ensure you have no comorbidities and can receive the treatment safely. If no problems are found and the CAR-T process is started, you may receive “bridging therapy,” using chemotherapy or radiation. This is to keep the cancer under control while your cells are being reengineered. It also reduces the number of lymphocytes (white blood cells that help fight off disease) so the CAR-T cells can grow more effectively.

After CAR-T therapy, you will be admitted to the hospital – from several days to up to two weeks – so you can be monitored for any side effects.

Our lymphocytes (white blood cells) are part of our immune system and fight off infections by identifying cells – such as cancer – that shouldn’t be there.

When lymphocytes recognize an abnormal cell, they penetrate it and become tumor-infiltrating lymphocytes, or TILs. Once in the tumor, they begin killing the cancer, but sometimes need help. 

Clinicians send the tumor tissue to a lab where they multiply the cancer-fighting cells, which you will then receive back through an infusion. You also will be given a growth factor so the TILs can do a better job of fighting cancer. 

TIL therapy is FDA-approved for those who have metastatic melanoma that has not responded to other treatments. 

If you are a candidate for TIL therapy, your surgeon will remove a portion of your tumor. Your tumor sample will be sent to a lab, where the TILs will be multiplied. This can take about three weeks. In the meantime, you will be given chemotherapy to reduce your old TILs, so your new TILs have room to grow. After chemotherapy, you’ll return home to rest.

The new TILs will be infused back to you with a central venous catheter. On the same day, you’ll receive an immunotherapy drug that will stimulate your TILs to multiply more. This process takes about five days in the hospital, and you’ll be monitored during this time. 

You will return to the Cancer Institute to see your medical oncologist once or twice a week for the first month. During these follow-up visits, you’ll be carefully monitored. Three months after your TIL therapy, you’ll receive a computed tomography (CT) or positron emission tomography (PET) scan, to see if your tumors are shrinking.