Bone Marrow and Stem Cell Transplant Program Reaches Milestone

Since it began in 1986, the Cook Children’s Bone Marrow and Stem Cell Transplant program has become one of the most diverse and experienced pediatric transplant programs in the Southwest. The program will perform its 1,000th bone marrow transplant on Thursday, Sept. 22.

The transplant program started at Cook Children’s under the direction of Paul Bowman, M.D., with a goal of keeping patients in need of transplant at the medical center instead of sending them across the country to other transplant sites far away from their home.

Over the last 30 years, thanks to burgeoning technology, participation in clinical trials and being a National Marrow Donor Program center for transplant, collection and donation, Cook Children’s has become the third largest transplant program in Texas.

It has grown from only a handful of matched sibling transplants into approximately 40 transplants annually.

“Where a transplant 20 years ago would have been a treatment of last resort, this is absolutely not the case today. It is now a very intense treatment we are offering patients early on in their therapy with the hope that we can save more children and they can live long and productive lives,” said Gretchen Eames, M.D., M.P.H, medical director of Cook Children’s Hematology and Oncology Center.

The marrow inside our bones is responsible for making the blood cells our bodies need. When this process is interrupted or fails, it can cause a wide variety of health problems, some of which can be life threatening.

The hematology and oncology team ask families to think of bone marrow as a big factory that makes billions of stem cells for your body to use:

• Bone marrow is the spongy stuff inside all of our bones.
• The stem cells are stored in the bone marrow until they are needed.
• When they grow up, the stem cells leave the bone marrow and move into the blood where they can do their jobs.

If a child’s bone marrow factory is not working right because of cancer, a blood disorder or other kind of damage, a stem cell transplant will replace the “old” factory and give him or her a brand new factory that works the right way.

Doctors decide who will be the source of stem cells for the child’s transplant. The decision is based on the child’s diagnosis and special blood testing called tissue typing. In general there are two types of stem cell transplant:

Autologous:

• The child will receive his or own stem cells and the transplant is needed to support the patient during very intensive chemotherapy.
• This type of transplant is often used for children with neuroblastoma; this type of transplant might also be used for Hodgkin lymphoma or certain types of brain tumors.

Allogenic:

• The child will receive stem cells from someone else who has a similar tissue type. This donor might be a brother or sister or maybe someone the child has never met through a donor program.
• This type of transplant is often used for children with leukemia, lymphoma, severe aplastic anemia or other blood disorders, certain metabolic disorders or certain types of inherited problems of the immune system.

Through the program’s affiliation with the National Marrow Donor Program (NMDP), Cook Children’s has access to donor registries from all over the world. These registries can find donors for bone marrow, peripheral blood stem cell and umbilical cord blood transplants.

The Cook Children’s Bone Marrow and Stem Cell Transplant program is actively involved in clinical research as well. The program is a member of the Center for International Blood and Marrow Transplant Registry (CIBMTR), the Pediatric Bone Marrow Transplant Consortium (PBMTC), Clinical Trials Network (CTN) and the Children’s Oncology Group (COG), as well as early investigational consortiums, including New Approaches for Neuroblastoma Therapy (NANT) and Therapeutic Advances for Child Leukemia (TACL).

“Seventy percent of patients in need of a bone marrow transplant don’t have a match in their family,” Dr. Eames said. “If they don’t have a match within their family, the only recourse is to look through national and international donor registries to find a match. In 1993, when we did our first unrelated donor transplant, that was a big step for our program and allowed us to treat more kids right here at home. Nowadays, nearly 50 percent of our transplants are from unrelated donors.”

At Cook Children’s, the primary patient diagnosis is Acute Lymphoblastic Leukemia (ALL) with 60 percent of the patients having a malignancy of some type and 40 percent being nonmalignant disorders, such as bone marrow failure syndrome, immune deficiencies, red blood disorders and metabolic disorders.

For more information:

Certain diseases and treatments can deplete a child's healthy stem cells. Sometimes the body needs help to replenish those cells. When this happens, your child may require a very complex process called a stem cell or bone marrow transplant. Click to learn more about the program.

Since 1986, Cook Children's Bone Marrow and Stem Cell Transplant program has performed nearly 1,000 transplants in children with cancer, blood disorders or inherited conditions. That's what makes this program one of the more diverse and experienced pediatric transplant programs in the Southwest.

Cook Children's is a member of:

• The Center for International Blood and Marrow Transplant Research (CIBMTR)
• Pediatric Blood and Marrow Transplant Consortium (PBMTC)
• The Children's Oncology Group (COG) stem cell transplant section.
• We are accredited through the Foundation for Accreditation of Cellular Therapy (FACT).

Over the last three years, 30 to 40 transplants were performed every year for a variety of diseases, with leukemia being the most common primary diagnosis.

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