Introduction
Stem cell transplant, also known as bone marrow transplant, is a procedure that can save the lives of people with certain blood cancers and blood disorders. It involves replacing the damaged or diseased blood-forming stem cells in the bone marrow with healthy ones from a donor or from oneself.
Stem cell transplant can be an effective treatment for a variety of hematologic malignancies, bone marrow failure syndromes, and rare and congenital blood disorders. Some of the conditions that may benefit from stem cell transplant are:
- Acute lymphoblastic leukemia (ALL)
- Acute myeloid leukemia (AML)
- Chronic lymphocytic leukemia (CLL)/SLL
- Chronic myelogenous leukemia (CML)
- Hodgkin lymphoma
- Non-Hodgkin lymphoma
- T-cell lymphoma
- Mantle cell lymphoma
- Follicular lymphoma
- Multiple myeloma
- Waldenström’s macroglobulinemia
- Blastic plasmacytoid dendritic cell neoplasm (BPDCN)
- Testicular or germ cell cancer
- Myelofibrosis
- Myeloproliferative disorders (MPD)
- Myelodysplastic syndromes (MDS)
- Chronic myelomonocytic leukemia (CMML)
- Aplastic anemia
- Diamond-Blackfan anemia
- Dyskeratosis congenita
- MonoMAC Syndrome
- Paroxysmal nocturnal hemoglobinuria (PNH)
- Shwachman-Diamond syndrome
- Sickle cell anemia
- Thalassemia
- Hemophagocytic lymphohistiocytosis (HLH)
- Immunodeficiency syndromes
Types of Stem Cell Transplant
There are two main types of stem cell transplant: autologous and allogeneic.
Autologous stem cell transplant means that the stem cells come from the patient themselves. The stem cells are collected from the patient’s blood or bone marrow before they receive high doses of chemotherapy or radiation therapy that destroy their bone marrow. The stem cells are stored and then given back to the patient after the treatment. This type of transplant reduces the risk of rejection and graft-versus-host disease (GVHD), which is a condition where the donor cells attack the patient’s tissues.
Allogeneic stem cell transplant means that the stem cells come from someone else, either a related or an unrelated donor. The donor’s stem cells must match the patient’s in certain ways to reduce the risk of rejection and GVHD. There are different sources of allogeneic stem cells, such as:
- Related donor transplant: The donor is a biological parent, child, or sibling who has a compatible tissue type with the patient.
- Haploidentical (“half-match”) transplant: The donor is a biological parent, child, or sibling who has a partially compatible tissue type with the patient.
- Unrelated donor transplant: The donor is someone who is not related to the patient but has a compatible tissue type. The donor can be found through registries such as Be The Match.
- Umbilical cord blood transplant: The stem cells are collected from the umbilical cord and placenta of a newborn baby and stored in cord blood banks. The cord blood units are matched to the patient based on blood type and tissue type.
Allogeneic stem cell transplant can have an additional benefit called graft-versus-tumor effect, which means that the donor cells can recognize and attack any remaining cancer cells in the patient’s body.
Stem Cell Transplant in the USA: Where to Go and What to Expect
Stem cell transplant is a complex and specialized procedure that requires a team of experts and a dedicated facility. In the United States, there are many hospitals and centers that offer stem cell transplant services for different types of conditions. Some of the factors that you may want to consider when choosing a stem cell transplant center are:
- The experience and reputation of the centre and its staff
- The accreditation and certification of the centre by organizations such as the Foundation for the Accreditation of Cellular Therapy (FACT) and National Marrow Donor Program (NMDP)
- The availability and quality of donor sources and cord blood units
- The outcomes and survival rates of previous patients
- The costs and insurance coverage of the procedure
- The location and convenience of the center
- The support and resources available for the patient and their caregivers
Some of the well-known and reputable stem cell transplant centers in the USA are:
- Dana-Farber Cancer Institute in Boston, MA
- Mayo Clinic in Rochester, MN
- Memorial Sloan Kettering Cancer Center in New York, NY
- Fred Hutchinson Cancer Research Center in Seattle, WA
- MD Anderson Cancer Center in Houston, TX
- City of Hope National Medical Center in Duarte, CA
Before undergoing a stem cell transplant, you will need to undergo a series of tests and evaluations to determine your eligibility and suitability for the procedure. You will also need to prepare yourself physically and emotionally for the transplant and its possible complications. You will need to have a caregiver who can assist you during and after the transplant.
The stem cell transplant process can vary depending on the type of transplant, the source of stem cells, and the condition being treated. However, a general overview of the steps involved are:
- Conditioning: This is the phase where you receive high doses of chemotherapy and/or radiation therapy to destroy your bone marrow and any cancer cells. This can last for several days or weeks and can cause side effects such as nausea, vomiting, hair loss, fatigue, mouth sores, infections, and bleeding.
- Stem cell infusion: This is the phase where you receive the stem cells through a vein in your chest or arm. This can take a few hours or days depending on the and amount of stem cells. You may experience side effects such as fever, chills, headache, low blood pressure, or allergic reactions.
- Engraftment: This is the phase where the stem cells start to grow and make new blood cells in your bone marrow. This can take several weeks or months depending on the type of transplant. You will need to have frequent blood tests and transfusions to monitor your blood counts and prevent infections and bleeding. You will also need to take medications to prevent or treat GVHD and other complications.
- Recovery: This is the phase where you gradually regain your strength and health after the transplant. This can take several months or years depending on your condition and response to the transplant. You will need to follow up with your transplant team regularly and follow their instructions on diet, exercise, hygiene, vaccinations, and medications. You will also need to cope with the emotional and social challenges of living with a stem cell transplant.
Stem Cell Transplant in the USA: Costs and Insurance Coverage
Stem cell transplant is an expensive procedure that can cost from tens of thousands to hundreds of thousands of dollars depending on the type of transplant, the source of stem cells, the centre where it is performed, and the complications that may arise. The costs may include:
- Pre-transplant tests and evaluations
- Hospital charges for the conditioning, infusion, engraftment, and recovery phases
- Medications and transfusions
- Donor search and testing fees
- Donor travel and lodging expenses
- Cord blood unit fees
- Post-transplant follow-up visits and tests
- Long-term care and rehabilitation
Most health insurance plans cover some or all of the costs of stem cell transplant for medically necessary conditions. However, there may be limitations or exclusions depending on your plan’s policy and your state’s laws. You may also have to pay deductibles, co-payments, co-insurance, or out-of-pocket expenses.
It is important to check with your insurance company before starting the transplant process to find out what is covered and what is not. You may also need to get prior authorization or approval from your insurance company for certain aspects of the procedure.
If you do not have insurance or if your insurance does not cover enough of the costs, you may be eligible for financial assistance from various sources such as:
- Government programs such as Medicare, Medicaid, Children’s Health Insurance Program (CHIP), Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), Veterans Affairs (VA), Indian Health Service (IHS), etc.
- Nonprofit organizations such as Be The Match, Leukemia & Lymphoma Society (LLS), American Cancer Society (ACS), National Foundation for Transplants (NFT), Patient Advocate Foundation (PAF), etc.
- Fundraising campaigns such as GoFundMe, GiveForward, YouCaring, etc.
You may also want to consult with a financial counselor or a social worker at your transplant center who can help you navigate the costs and insurance issues related to stem cell transplants.
Conclusion
Stem cell transplant is a life-saving procedure that can offer hope and cure for people with certain blood cancers and blood disorders. However, it is also a complex and risky procedure that requires careful planning and preparation. If you are considering stem cell transplant in the USA, you should consult with your doctor and your transplant team about the benefits and risks involved. You should also research the different types of transplants, sources of stem cells, centers that offer them, costs involved, the insurance coverage available, financial assistance options, etc.
