What is cellular therapy?

What is cellular therapy?
Cell therapy is the use of blood cells from your own body or in some cases from an appropriate donor to treat your blood disorder. There are many different kinds of cellular therapy:

Autologous Bone Marrow (or Stem Cell) Transplant
Certain blood cancers, especially myeloma and lymphoma, can be treated with chemotherapy.  However, the dose of chemotherapy is often limited by the ability of the bone marrow (blood making cells) to withstand the damage from rounds of such chemotherapy. In certain cases, higher doses of chemotherapy can better control or even cure the disorder. However, to safely administer such therapy we need to harvest some of your own healthy stem cells (the origin of all blood cells) and safely store them at very cold (liquid nitrogen) temperatures. We can then use those stored cells to save you from prolonged low blood counts after treating you with higher dose chemotherapy. The process of harvesting your own stem cells and then giving them back after high dose therapy is termed “autologous” because the cells come from you.

Allogeneic Bone Marrow (or Stem Cell) Transplant
Certain other blood cancers, especially leukemias, cannot be cured with even higher doses of chemotherapy. However, transplant of cells from a closely-matched donor can give you a new immune system (since all the cells of your immune system come from the bone marrow). That new immune system in your body can attack and destroy some blood cancers and lead to cure in many cases. However, the major complication of this form of therapy is that the new immune cells may also attack parts of your normal body cells (what we call “graft-versus-host disease”). It’s very important that we find a closely-matched donor, give you the right therapy and follow up to allow the new cells to set up a new immune system that can control or cure the cancer, but not cause serious graft-versus-host disease. The process of finding a donor, harvesting their cells (which are then given to you after appropriate therapy) and the follow up for months thereafter to ensure success is termed “allogeneic” because the cells come from someone else. Sometimes the allogeneic donor may be a volunteer donor from anywhere in the world. There is a network of such donors coordinated by the National Marrow Donor Program (NMDP). For more information, please visit the NMDP website at https://bethematch.org.

Haploidentical Bone Marrow (or Stem Cell) Transplant
For some patients who would benefit from an allogeneic transplant we cannot find a well matched donor. Recent advances have allowed us to safely consider only half-matched or “haploidentical” donors in those situations. Only well-qualified and experienced centers such as ours can safely perform this newer procedure.

Cord Blood Transplant
For some patients who would benefit from an allogeneic transplant, we cannot even find a haploidentical donor. In those rare cases, we can sometimes use stem cells from the umbilical cord immediately after a baby is born. This blood is rich in stem cells and can be frozen and stored for later use.  Only well-qualified and experienced centers such as ours can safely perform this newer procedure.

CAR-T Therapy
The newest therapy available to treat difficult blood cancers that are resistant to other therapies, including those listed above, is Chimeric Antigen Receptor T-cell (Car-T) therapy. For this therapy, our center would harvest your blood lymphocytes, then introduce a new gene to those cells that would enable your own lymphocytes to attack and destroy your blood cancer even when your own immune system is unable to attack the cancer cells itself.  This therapy is not yet available for all blood cancers but we will be performing clinical trials of this new technique in many different blood cancers. Learn more about CAR-T Therapy in this video with Dr. Robert Emmons.

How do we obtain the cells we need for therapy?
Most of the time we can harvest blood cells right from your bloodstream using a technique called cellular apheresis. We can obtain the blood lymphocytes we need for Car-T therapy directly, but if we need stem cells (like for autologous or allogeneic transplant) we need to stimulate the stem cells to go into the blood stream with certain medicines that you can receive as an injection for several days. All of these cells come originally from the bone marrow but only rarely do we need to actually obtain the stem cells directly from the bone marrow using a technique called a bone marrow harvest. Finally, we sometimes use cells obtained from umbilical cord blood in rare cases as noted above.

Specialized Patient Facility
Cellular therapy of any kind usually requires you to stay in a special unit to limit the chance of getting an infection and to provide you with specialized care. How long you must stay depends on how much chemotherapy or radiation you received, the type of transplant you have, and how fast you are recovering.  Sometimes we can have a patient do an entire transplant as an outpatient if they live locally and have good family support to visit the hospital daily for the early phase of transplant.

UofL Brown Cancer Center’s BMT Program maintains a 16-bed specialty care unit at UofL Hospital. Physicians are available 24 hours a day, seven days a week, including holidays and weekends. Each room is private and equipped with complete monitoring systems that allow staff to continually check your progress. A HEPA-filtered air handling system, special flooring, and copper fixtures with antimicrobial properties help protect you from infection. Each room also includes a private restroom and many include a sleeping area for family members so they can be with you along the way. Those who need extended stays even have access to a kitchenette and laundry facilities.