Stem Cell Transplantation for Myelodysplastic Syndromes

Doctors at the Blood and Marrow Transplant Program, part of NYU Langone’s Perlmutter Cancer Center, may recommend stem cell transplantation for people with myelodysplastic syndromes that have a high risk of progressing to acute myeloid leukemia, commonly known as AML. It is the only treatment that can result in a remission, meaning blood cell levels return to normal and blasts are no longer present.

People younger than age 70 who are otherwise in good health may be eligible for a stem cell transplant. The procedure is performed at the Rita J. and Stanley H. Kaplan Blood and Marrow Transplant and Cell Therapy Center.

Stem cells are immature cells that are made inside the bone marrow. They mature into many different kinds of blood cells.

Before stem cell transplantation, you are given a high dose of a chemotherapy drug, which destroys rapidly multiplying cells throughout the body. Chemotherapy is given through a vein with intravenous (IV) infusion daily for several days. This destroys the bone marrow, including the damaged stem cells that cause myelodysplastic syndrome and immature blast cells that further exacerbate the condition.

The bone marrow is then replaced with healthy stem cells provided by a donor, a process called allogeneic stem cell transplantation. These stem cells travel through the bloodstream and enter and repair the bone marrow, so it can produce healthy levels of blood cells and blast cells. Your doctor then watches for signs that the donated stem cells are making new, healthy blood cells in your body.

You may spend several weeks in the hospital during stem cell transplantation.

Finding a Stem Cell Donor

An allogeneic stem cell transplant requires a donation of bone marrow stem cells from a healthy person who is a “match.” This means the person’s genetic makeup and tissue types are compatible with your own. Siblings are frequently the best matches, but other family members may also be good candidates. If necessary, NYU Langone specialists can help you locate an unrelated donor using national bone marrow registries.

It can take weeks to months to find an appropriate donor or donors and to perform the necessary testing. Your doctors may recommend an additional cycle of chemotherapy until the search is complete, especially if it takes longer than anticipated.

Stem Cell Collection and Transplantation

After a match is made, a doctor collects, or harvests, stem cells from the donor. This can be done using different techniques. One option is peripheral blood stem cell harvest, in which the doctor collects blood from a vein in the donor’s arm. Blood is passed through a special machine that separates out the stem cells and then returns other blood cells to the donor’s body. Peripheral stem cell collection takes place either in an NYU Langone infusion center or at the hospital. The donor can go home that same day.

Rarely, doctors collect stem cells through bone marrow retrieval surgery, in which a needle is inserted into the donor’s hipbone under local anesthesia to remove the cells. The procedure takes place in the hospital or at a special apheresis unit, and the donor can usually go home the same day.

Stem cells can be given to you on the same day they are collected. This is done through an IV infusion at the hospital. Sometimes, the cells are frozen for use at a later date.

Recovery from Stem Cell Transplantation

In the first days after a stem cell transplant, blood cell levels drop, making you vulnerable to infection and bleeding. Your doctors monitor you closely in an isolation room at NYU Langone for about four weeks.

During this time, you receive antibiotics to prevent or manage infection. You also get transfusions of red blood cells and platelets to manage bleeding. Your doctor prescribes medications to prevent graft-versus-host disease, which occurs when the donated cells attack healthy tissue in the body. He or she manages any other side effects that you may experience and takes steps to prevent them from worsening.

NYU Langone also offers support services, which provide physical and psychological assistance to people who have had a stem cell transplant.