Bone Marrow Transplant

Innovative Bone Marrow Transplant Programs at Mayo Clinic

Mayo Clinic's Bone Marrow Transplant Program offers a number of specialized treatments not available in many other centers.

• Stem cell transplant for amyloidosis

• Haploidentical allogeneic BMT for patients without donors
  Haploidentical allogeneic peripheral blood stem cell transplant offers an innovative option for patients who cannot be suitably matched with a family member, or who do not have an unrelated donor readily available for transplant. This technique makes it possible to use partially matched family members as donors.

  In this new procedure, peripheral blood stem cells are collected from the donor, and depleted of T cell lymphocytes known to cause graft-versus-host disease. The first treatment phase for the patient includes chemotherapy, immunosuppressive drugs, and radiation. Transplant specialists can then infuse the prepared cells from the donor into the patient's body. This transplant method allows physicians to select a partially matched donor from the patient's family whose white blood cells will act as natural killer cells against the leukemic cells of the patient.

  Clinical researchers in hematology and bone marrow transplant at Mayo Clinic pioneered this new type of transplant in the United States. Italian physicians developed the original procedure. At present, patients 30 or younger can participate in a research protocol that uses this technique. A new study is in development for treatment of older adults as well.

• Radionuclides combined with chemotherapy for BMT in patients with lymphoma
  Autologous stem cell transplant using high-dose chemotherapy can be curative for some patients with lymphoma. Lymphoma cells are also sensitive to radiation therapy. "Zevalin" combines a radioactive isotope (Yttrium-90) with an anti-CD20 antibody (Rituximab) to create a radioactive antibody which will target lymphoma cells. This treatment has been called "radioimmunotherapy" or "antibody targeted irradiation." Zevalin was approved by the United States Food and Drug Administration for the treatment of non-Hodgkin's lymphoma (NHL) in February 2002 and Mayo Clinic was a leading investigator in those initial clinical trials. Zevalin can be very effective in the treatment of patients with NHL. By combining Zevalin with high-dose chemotherapy and autologous stem cell transplant we hope to improve the outcome of transplant for NHL compared to high-dose chemotherapy alone.

• Radionuclides combined with chemotherapy for BMT in patients with myeloma
  Autologous stem cell transplant is effective for patients with multiple myeloma. Myeloma cells are sensitive to both chemotherapy and radiation therapy. Most autologous stem cell transplants for multiple myeloma use chemotherapy alone. Using total body irradiation has more side effects. Samarium is a radionuclide that can deliver radiation directly to bone and therefore minimize risks of radiation compared to total body irradiation. Research is ongoing.

• Immunotherapy to prevent recurrence of disease after BMT
  Although autologous stem cell transplant can be curative for some patients with blood related cancers, some patients will still relapse after a transplant. The immune system has been shown to help reduce the likelihood of relapse post-BMT. Mayo Clinic is investigating how to modulate the immune system post-transplant to decrease relapse post-BMT.

  Clinical trials are investigating immune system recovery post-BMT and how to modify the immune system recovery.

• Non-myeloablative allogeneic BMT
  Allogeneic BMT can be curative for patients with blood-related cancers including leukemia, lymphoma, multiple myeloma, as well as some patients with solid tumor cancers such as renal cell cancer. However, many patients are not eligible to undergo allogeneic BMT because of their age or because they have underlying medical problems that would increase the toxicity of the transplant.

  Non-myeloablative allogeneic BMT uses a milder form of chemotherapy and/or radiation therapy for a stem cell transplant. These transplants have also been called "mini-allogeneic BMT" or "reduced-intensity allogeneic BMT." The chemotherapy and/or radiation therapy will suppress the patient's immune system to allow the patient to accept the donor's stem cells, which will eventually replace the patient's own stem cells. Because these transplants use milder forms of chemotherapy and/or radiation therapy, older patients and patients with underlying medical problems who would otherwise be excluded form allogeneic transplants may be eligible for a non-myeloablative BMT.

  Mayo Clinic performs non-myeloablative allogeneic BMT for many diseases. A clinical trial for patients with metastatic renal cell carcinoma is investigating non-myeloablative allogeneic BMT.