Adult bone marrow transplant
Duke is internationally recognized for its novel approaches to treating leukemia, lymphoma and multiple myeloma through bone marrow, cord blood and stem cell transplants. We are one of the nation’s leading centers of bone marrow and stem cell transplantations; we've performed more than 4,500 transplants since 1984, and currently perform about 300 annually. Our bone marrow transplant research has reduced the associated complications, which has made it possible for people who were not previously eligible to undergo bone marrow transplantation.
Duke’s bone marrow transplant program saves lives
Our specialists use bone marrow and stem cell transplants to treat leukemia, lymphoma, multiple myeloma and brain tumors. We perform more blood and marrow transplants than any other medical center in the area. We are one of the nation’s few programs to use bone marrow to treat autoimmune diseases, sickle cell disease and other red blood cell-related diseases. Learn more about our pediatric blood and bone marrow transplant program, and our latest innovations and treatments for children.
A stem cell transplant replaces or regrows the immune system after you receive high dose chemotherapy and/or radiation therapy. Several terms are used for stem cell transplant because stem cells can be obtained from the bone marrow, blood, or umbilical cord blood. A blood and bone marrow transplant transfers healthy bone marrow cells when your own unhealthy bone marrow has been eliminated following cancer treatment such as chemotherapy or radiation. Stem cell transplants replace the cells responsible for forming blood that were destroyed by cancer treatments so your body can continue to make healthy blood cells. There are also different types of transplants. Your adult bone marrow transplant team will perform a comprehensive evaluation to determine if you will benefit from an autologous transplant (during which you receive your own stem cells), an allogeneic transplant (in which you receive cells from a related or unrelated donor), or a syngeneic transplant (in which you receive stem cells from your identical twin, if one exists).
- Top ranked care. We are consistently ranked among the best cancer programs in the nation by U.S. News & World Report. In addition, we are one of only a few National Cancer Institute-designated Comprehensive Cancer Centers, which is dedicated to improving patient outcomes. We are also part of the National Comprehensive Cancer Network (NCCN), an alliance of the nation’s leading cancer centers dedicated to improving care for our patients.
- Out patient treatment and follow up. We are one of the only programs in North Carolina where you will receive the majority of your care in our day hospital as an out patient. This allows you to live in the comfort of your own home, or nearby temporary residence. If you are eligible to receive your own cells, you may spend no time in the main hospital as in patient. If you receive donor cells, your may spend a portion of your time in the hospital, and undergo your remaining transplant care as an out patient.
- Nationally renown experts Our experts are pioneers in blood and marrow transplantation. We performed the first cord blood transplant in 1993, and we are currently leading the nation's first clinical trial to offer bone marrow transplant care in the home.
- Transplant research expands eligibility. Our scientists can manipulate donor blood cells to reduce complications and make transplants available to more people. Our research is especially vital in adult bone marrow transplant, as fewer than 25 percent of adults have access to closely matched donors.
- More transplant options. We offer stem cell transplantation as an option to a broader number of people — including those who are older or lacking a closely matched donor — using less intense chemotherapy regimens and careful selection of donor cells. Donor cells may be identified from a family member, an unrelated donor who is registered in the National Marrow Donor Program, or publicly donated umbilical cord blood also identified through the National Marrow Donor Program.
- Access to clinical trials. You may have access to the latest therapies through our innovative research programs and clinical trials, which test experimental therapies and provide new therapies for people with advanced or complex diseases. For example, you may be eligible to particpate in a study which is exploring transplant care in the comfort of your home.
- Personalized attention and care. Your transplant coordinator will facilitate the transplant process. She or he will be in charge of coordinating all of your tests, exams, and treatments at Duke. At the same time, we assist you in finding nearby housing during your weeks-long treatment, and help you navigate through any financial and insurance concerns. We are a preferred provider for most major health insurance carriers.
- A team of specialists. In addition to your transplant coordinator, a dedicated team of board-certified hematologists and medical oncologists, clinical pharmacists, specially trained nurses, dieticians, and social workers will follow you throughout your transplant process. They meet regularly to discuss your care, collect opinions, and offer the best recommendations for your needs.
- Support for you and your family. Our comprehensive cancer support services help you and your loved ones minimize the side effects of treatment, and cope with the emotional and psychological effects of diagnosis and treatment.
ADULT BONE MARROW TRANSPLANT
Preparing for your transplant
In preparation for a transplant, you will need to make several trips to Duke. After a comprehensive evaluation by your adult bone marrow transplant team, you will undergo tests to ensure it is safe for you to have the transplant.
Blood will be drawn to evaluate your past exposure to certain viruses and to check your organ function. These tests will help us treat you before and after your transplant.
We search for stem cell donor matches based on your HLA typing. This blood test will be repeated at our lab even if it was done previously at your home physician's office or the American Red Cross. It is the responsibility of the transplant center to verify your typing. Any potential donors will also have HLA typing compared with yours to see if they are a suitable match.
Evaluates the pumping ability of your heart. In an echocardiogram, an instrument that transmits high-frequency sound waves called a transducer is placed on your ribs near the breast bone and directed toward the heart. The transducer picks up the echoes of the sound waves and transmits them as electrical impulses. The echocardiography machine converts these impulses into moving pictures of the heart.
Evaluates your lung function. You will be asked to breathe into a machine that will measure different capacities of your lungs.
CT, MRI, and PET scans are similar to x-rays but utilize computers to produce pictures of the area being evaluated.
A small sample of bone marrow is taken from the back of the hips. The biopsy is evaluated to determine how well your bone marrow is producing cells, and to look for any signs of disease in the marrow.
ADULT BONE MARROW TRANSPLANT
Once it is determined that you are a successful candidate for transplant, the following steps will be taken. Post-transplant tollow-up care will help you return to optimal health.
Your team will determine which type of transplant is right for you. The options are:
- Donor transplant. A search to identify a donor will take place on your behalf with immediate family members and the National Marrow Donor Program (NMDP). Arrangements will be made for the cells to be harvested.
- Autologous transplant. Your stem cells will be harvested and frozen for your use after your conditioning regimen.
Chemotherapy alone, or chemotherapy with radiation therapy kills any cancer cells in your body. The conditioning regimen also makes room in your bone marrow space for the transplanted cells to grow. You may experience side effects related to the chemotherapy and radiation treatments. You receive your stem cell transplant after you complete the conditioning regimen. The transplanted cells enter your bloodstream in a method similar to a blood transfusion.
Following your transplant, you will receive supportive care in our daily clinic with medicines, monitoring for side effects and symptom management. You will be required to stay at Duke, or live locally for 30-90 days following your transplant. This is to ensure a safe recovery following your treatment. You will also be required to have a caregiver with you at all times.
Once you complete your treatment, you will be discharged back to the care of your referring or home doctor. Periodically, you will be required to undergo tests, either here or with your doctor, to monitor your response to therapy and major organ function.