Скачать или смотреть Parallel Journeys: Stem-Cell Transplants

A stem cell transplant is a powerful treatment for blood cancers and other blood disorders. The goal of a stem cell transplant is always the same: to cure the disease or significantly extend a patient’s life. At Dana-Farber, every step is guided by decades of expertise, from collecting and processing stem cells to infusion. During this time, patients and their cells travel parallel journeys before being reunited.

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TRANSCRIPT:
A hematopoetic stem cell transplant, a treatment for many types of blood cancers and other blood disorders, involves many steps. Dana Farber's clinical, laboratory, and operations teams have decades of experience with all aspects of the stem cell transplant journey.

There are two types of stem cell transplants. Autologous transplants that use a patient's own stem cells and allogeneic transplants that use stem cells collected from a healthy donor.

Step one: cell collection.

The first step is collecting millions of stem cells, the building blocks of all blood cells, including white cells, red cells, and platelets. For most patients or donors, stem cells are collected through a process called leukapharesis . Patients or donors are given medicine that sends stem cells out of the bone marrow and into the bloodstream. Then blood is drawn through an IV into a centrifuge which separates out the stem cells and returns the remainder of the blood to the body. The stem cells are gathered in collection bags. For some patients and donors, the stem cells are collected through a bone marrow harvest from bones in the pelvis during an outpatient surgical procedure.

Step two: processing the cells.

The collection bags are then brought to our Connell and O'Reilly family's cell manipulation core facility or CMCF. There the stem cells are tested and processed to prepare them for patients. And this is where the stem cell journeys for autologous and allogeneic transplants diverge.

For autologous transplants, stem cells are frozen until the patient is ready to receive them. This is because fresh stem cells are viable for only 48 to 72 hours. And autologous patients are not ready to receive their stem cell transplant right away. They may receive other treatments first and need time to receive conditioning chemotherapy to make room for the stem cells in their bone marrow. In allergenic transplants where the stem cells come from a healthy donor anywhere in the world, the cells are usually not frozen. A high level of coordination is needed to make sure these cells are infused within 72 hours. As soon as the donor cells arrive at the CMCF, they're processed. Technicians perform manipulations such as plasma or red blood cell reductions to improve compatibility with the patient. They may also do complex processing to select out purified stem cells or enrich for other types of immune cells depending on the needs of the patient. Some of these cells may be given to the patient immediately. Others may be saved for future use.

Step three: the day of transplant.

On transplant day, the bag of cells is brought to the patients bedside for infusion. The cells are then infused into the patient's bloodstream through an IV. The infusion can take between 15 minutes to 2 hours. In the body, the infused stem cells find their way to the bone marrow and begin to produce healthy new blood cells, including red blood cells, platelets, and other components of the immune system. This process, called engraftment, usually takes 12 to 18 days.

Full recovery after a stem cell transplant can take up to a year or so.