Q: What sort of blood cancers can be helped by a bone marrow transplant? >>
A: There are many cancers that can benefit from this sort of treatment, such as leukemia, lymphoma, multiple myeloma and neuroblastoma.
Q: How many people are there in Qatar with blood cancers? >>
A: Nearly 500 people have been diagnosed with a hematological cancer in Qatar in the last three years. We believe we will have approximately 80 candidate patients each year.
Q: What is the difference between bone marrow transplant and stem cell transplant? >>
A: The difference in a bone marrow transplant and a stem cell transplant is simply the location from which the stem cells are taken. For example, blood stem cells can be found in the bone marrow and in the circulating blood. A bone marrow transplant involves "harvesting" the stem cells from the bone marrow. Stem cell transplants involve "harvesting" stem cells from the circulating blood.
Q: What is the process for an autologous bone marrow/stem cell transplant? >>
When a patient has a blood cancer, the main treatment is chemotherapy to stop the growth and spread of cancerous cells through the blood. Through this treatment a patient can be brought to a point where they have no more cancer cells in their blood. However, the cancer will grow back as new cells are generated, which is why a bone marrow/stem cell transplant is important. During this time, when the patient has no signs of cancer, we harvest their healthy stem cells.
The stem cells are collected from the patients’ blood using a special mobilization process and bespoke equipment. This is the most advanced technique, and the most convenient and safe method for the patient. It is a complicated procedure and requires a special environment and highly trained healthcare professionals, such as the Bone Marrow Transplant Unit at the National Center for Cancer Care and Research. The preparation of the patient takes days and the procedure itself takes several hours and requires the involvement of highly trained expert staff.
Once the harvest of cells is completed, the patient has a break, during which time the cells are examined and stored properly in a specialized laboratory.
After this break, the patients are admitted to the hospital for a high dose of chemotherapy that kills off their diseased bone marrow. At which point the healthy cells, that were harvested from them before, are transplanted back into their bodies to enable healthy, disease free bone marrow to grow, thus consolidating the treatment the patient has been given so far. We then monitor the patients in a clean and isolated environment to ensure they do not pick up any infections.
Q: Why is there a special unit for bone marrow transplant patients? >>
A: We have a state-of-the-art unit in the National Center for Cancer Care and Research for bone marrow/HSCT transplant patients. It has been built to be bespoke for the needs of these patients. During the treatment process the patient can be very susceptible to infections due to a compromised immune system. The unit includes five single, positively pressurized isolation HEPA filtered rooms to keep patients free from the risk of infection. There is a team of highly specialized healthcare professionals working on the Unit to support patients.
Q: Will the Bone Marrow Transplant Unit at the NCCCR be treating children? >>
A: Currently the program is looking after patients 14 years old and over. We do plan to develop a pediatric program but it will require the development of a different set of protocols and policies. We do, however, have staff who are specialists in pediatric bone marrow/stem cell transplant and who will be integral to the pediatric program’s development.
Q: Is there a bone marrow transplant donor program in Qatar, like there is for organ donation? >>
A: Currently the program being operated at the National Center for Cancer Care and Research is for autologous and allogeneic transplants. We are developing an unrelated donor registry in Qatar.
Q: What is allogeneic transplant? >>
A: In an allogeneic transplant, the patient receives bone marrow or
peripheral blood stem cells from another person - usually a sibling, but
sometimes an unrelated donor. This is different from an autologous
transplant in which some of the patient's own marrow or peripheral blood
stem cells are removed, treated and then given back.
Q: What is the difference between bone marrow and peripheral blood stem cell
transplant? >>
A: In a bone marrow transplant, some marrow (about 5 percent) is “harvested”
from the donor’s hip bone in an operating room under general anesthesia.
These cells are pooled, processed and transfused into the patient.
Peripheral stem cells, on the other hand, can be taken from the blood
circulating in the body after the donor is injected with a growth factor
called Granulocyte Colony Stimulating Factor (G-CSF). This medication
stimulates the donor's bone marrow to produce excess quantities of stem
cells which are released into the circulating blood. The donor's blood is
drawn and a special blood processing system concentrates the stem cells.
These cells are transfused into the patient. The donor experiences no
surgical pain.
A peripheral blood stem cell transplant generally provides more stem cells
and results in a more rapid recovery of white blood cells and platelets.
However, it may be associated with a higher risk of chronic graft vs. host
disease.
Q: When is allogeneic bone marrow or peripheral blood stem cell transplant
an appropriate treatment? >>
A: Some of the diseases for which bone marrow/peripheral blood stem cell
transplant may be used are: acute leukemia, chronic leukemia, Hodgkin’s
lymphoma, Non-Hodgkin's lymphoma, multiple myeloma, myelodysplastic
syndromes, aplastic anemia, thalassemia, and sickle cell anemia.
Q: How are transplant patients selected? >>
A: Potential patients are carefully evaluated to determine if transplant is
the best treatment option. Some of the criteria considered are age, overall
medical status, type and stage of disease, and disease progression. Your
transplant team will thoroughly discuss all of the risks and benefits with
you and your family.
Q: Who can be a donor? >>
A: Anyone whose tissue antigens - HLA antigens (Human Leukocyte Antigens)
match yours - and who is otherwise healthy, can be a donor. But finding that
person can be a challenge. There may be a match in your own family (siblings
or, less likely, a parent or child may share your genetic make-up). If a
match is not found within your family, a search could begin within the
general population through donor registries. Patients who cannot have HLA-matched
family donor and could not find a matched unrelated donor could be given
transplantation from a partially matched family donor. Your transplant
coordinator can give you more information about the search process.
Q: How is an allogenic bone marrow or peripheral blood stem cell transplant
performed? >>
A: For a peripheral blood stem cell transplant, a related donor comes to the
hospital the day of the transplant. Through a process called apheresis, the
donor's blood is removed through a vein in the arm or through a catheter
inserted into a large vein in the neck or chest area. The blood is
circulated through special machine that collects the stem cells. The blood
is then returned to donor and the stem cells are stored. Apheresis typically
takes 4 to 5 hours to complete. The collected stem cells are processed and
are transplanted to the patient.
For a bone marrow transplant, bone marrow will be collected from the donor
under general anesthesia in an operating room. Approximately one liter (two
pints) of bone marrow will be removed from the hip bones in the back through
multiple aspirations. The procedure lasts about 90 minutes.
Q: What happens after the bone marrow or stem cells have been transplanted
to the patient? >>
A: After entering the bloodstream, the transplanted cells travel to the bone
marrow, where they begin to produce new white blood cells, red blood cells
and platelets. This process is called "engraftment." It may take 10 to16
days for engraftment to occur after transplantation. Doctors monitor whether
new blood cells are being produced by checking blood counts daily. Periodic
bone marrow aspirations (the removal of a small sample of bone marrow
through a needle for examination under a microscope) can also help doctors
determine if engraftment has been successful.
Q: Are you planning to use stem cells that come from umbilical cords? >>
A: Due to increased use of haploidentical transplants worldwide, the use of
cord blood as alternative source of stem cells in adult patients
significantly decreased. Therefore we are planning to use haploidentical
transplants for patients who have neither matched related nor unrelated
donor. However, in pediatric patients cord blood is still used frequently.
