City of Hope is a leader in the use of stem cell transplantation
to treat lymphoma and other blood disorders. Since the program began in 1976, more than 12,000 transplants have been performed and it has been recognized for superior survival outcomes
for nine consecutive years—the only transplant center in the United States with such an achievement.
Transplants are sometimes performed early in the course of treatment to improve long-term results or it may be utilized when other treatments are not working.
In this procedure, a patient undergoes intensive chemotherapy, and sometimes radiation therapy, to destroy the cancer-causing cells followed by an infusion of healthy new stem cells. The stem cell transplant may be either autologous (extracted from the patient’s own body) or allogeneic (using stem cells taken from another person.)
In autologous transplants, a patient donates and receives back his or her own stem cells, typically collected from peripheral (circulating) blood. City of Hope has pioneered the use of early autologous stem cell transplantation in patients with aggressive non-Hodgkin lymphoma to avoid relapse after initial treatment. This is also the most effective treatment for most patients with a lymphoma recurrence.
Patients with Hodgkin or AIDS-related lymphomas are sometimes good candidates for autologous stem cell transplantation. City of Hope is currently conducting studies using genetically engineered autologous stem cells to provide additional resistance against HIV infection for patients with AIDS-related lymphoma.
For some patients, particularly those whose disease have advanced extensively throughout the body and bone marrow, an allogeneic transplant is preferred, using stem cells from a matched donor or cord blood.
In allogeneic transplants, the donor is preferably a relative with a matching stem cell type. Alternatively, a matched unrelated donor who has a similar genetic type may be used. At City of Hope, 45 percent of allogeneic transplants come from volunteer donors who are unrelated to the patient.
One known complication of allogeneic transplants is graft versus host disease (GvHD), in which the newly transplanted cells does not recognize the recipient’s body as their own and forms an immune response against it. City of Hope is on the forefront of tackling this side effect and is constantly improving allogeneic transplant protocols to reduce GvHD risk and minimizing its impact if it does occur.
City of Hope physicians also specialize in “mini” stem cell transplants for patients who cannot tolerate the side effects associated with a standard stem cell transplantation, such as older patients or patients with other medical conditions. These transplants rely less on the heavy doses of chemotherapy and radiation and more on the antitumor effects of the graft itself. This novel approach has patients who otherwise ineligible, including patients in their 70s, to be treated with this lifesaving procedure.