Bone marrow transplantation is the replacement of a damaged or completely destroyed bone marrow with new bone marrow cells. Bone marrow transplantation can be a life-saving method in Acute Leukemias and Lymphomas which are resistent to standard chemotherapy.
Stem cells might be collected from our own body or another person. This other person is called donor.
Autologous transplantation is the procedure of using the person’s own stem cells. This method of transplantation is mainly used in Multiple Myeloma and Lymphoma patients.
Full Matched Allogenic transplantation is the procedure of using another person’s fully compatible stem cells. This is preferably a Full Matched sibling of a patient.
Matched Unrelated Donor Transplantation: Performed for patients who do not have a full matched sibling. It is found by searching National and International BoneMarrow Banks.
Haploidentical Transplantation: Performed for patients who do not have a full matched sibling and in urgent need of transplantation. Donor is a half matched sibling, mother, father or child of the patient. It is a relatively new method and can be as effective as Matched Unrelated Donor Transplantation in experienced centres.
A very special method oftransplantation that is currently perfomrned in only a few centers worldwide is the Haploidentical stem cell transplantation .This methodis likely to eliminate the problem of finding a donor completely and therefore considered as the transplantation method of the future. 10/10 tissue match is not considered essential in Haploidentical transplantation, and the mother, father, semi-compatible sibling or the child of the patient can be a donor even if ther e is only half compatibility.
Bone marrow transplantation is performed in individuals who have diseases affecting the bone marrow such as leukemia or myelodysplastic syndrome, other hematological malignancies such as Lymphomas and Multiple Myeloma, Aplastic anemia where the bone marrow cannot provide adequate blood-forming cells. It can also be used in a number of chemotherapy unresponsive Oncological cancers such as testicular cancer, neuroblastoma and medulloblastoma and Congenital disorders such as Thalassemia, Sickle cell disease, Porphyrias, severe immunudeficiency disorders.
High-dose chemotherapy leads to nausea, diarrhea, fever, hair loss, and need for blood and platelet transfusion. Within two weeks after the transplantation, the new cells find their places and start producing cells. Patient’s general condition improves with elevating blood cells levels, and then, they get to a point where they can be discharged. From that point on, they return for follow-up visits at regular intervals.
The follow-up period after the transplantation at Altunizade Acıbadem Hospital varies between 3 months to a year depending on the progress of the patient who is then returned to be followed up in the home country. Within the first year, the patient’s immune system needs to be protected as it is affected by the therapy. They are advised to avoid crowded environments because even upper respiratory tract infections that are transmitted from other people may require inpatient treatment. Therefore, the patients are advised to reorganize their lives. Provided that these warnings are not ignored, majority of the patients can return to their work life within 3-6 months. Additionally, they are also advised to eat cooked meals and eat peeled fruits and vegetables for the first few months.
In some cases, the fertility may be affected due to chemotherapy. Families who are planning to have children are sometimes able to do so using in vitro fertilization method. If there is time before initiating treatment, freezing sperms or ova might be an option.
Services are provided in a sterilized environment conforming to international standards. Interdisciplinary work is important in bone marrow centers. When necessary, support is provided by all relevant branches such as intensive care unit, general surgery, cardiology, nephrology and ear-nose-throat. Transplanted stem cells are prepared in licensed GMP laboratory of Acıbadem Healthcare Group; and all cells are analyzed for vitality, count and activity prior to the transplantation procedure.
CAR T-cell therapy is a new type of cancer treatment using immune cells to attack tumors. Acibadem is first in Turkiye and the region to apply the new treatment.
CAR T-cell treatment is a form of immunotherapy that modifies the targeting mechanism of the immune system to fight cancer. The therapy is customized for each patient, using T cells, the major component of our immune system.
In CAR T cell immunotherapy, T-cells are derived from the body and genetically engineered in laboratory settings to produce specific chimeric antigen receptors (CARs). When modified T-cells are infused back into the patient, the new receptors enable them to identify particular antigens of the cancer cells and destroy the tumor.
Up to date, CAR T-cell therapy is approved for refractory B-cell Acute Lymphoblastic Leukemia (B-ALL), B-cell Lymphoma, and Multiple Myeloma. At Acibadem, the CAR-T treatment carries the CD-19 receptor. It can be considered for patients with post-transplant relapsed or refractory B-cell Acute Lymphoblastic Leukemia and Non-Hodgkin Lymphoma (NHL). Our product will be ready in the next 1 year for clinical trials on multiple myeloma.
For successful CAR T-cell therapy, the patient should be in good overall health, and the tumor load should be low. Therefore, our physicians will mostly prescribe bridging chemotherapy and/or radiotherapy before the procedure to increase treatment success.
If you are found eligible for CAR T-cell therapy, your or your donor’s peripheral blood cells will be collected with a device by apheresis. This procedure lasts about 2 to 4 hours. Next, the genetic structure of these cells will be engineered, and they will be proliferated in laboratory settings. The final product will be frozen and stored for you until quality assurance tests are completed. Production and quality control processes of CAR-T cells will take approximately 21 days.
Meanwhile, before the therapy starts, a dual-agent chemotherapy protocol for lymphodepletion will be maintained for 4 days to create room for modified CAR-T cells in your body. 48 hours should elapse to help the excretion of drugs from the body. Finally, personalized CAR T-cells will be intravenously administered within 30 minutes.
CAR-T cell therapy is an approximately 2-week treatment that includes the lymphodepletion and administration of CAR T-cells. After the procedure, side effects such as cytokine release syndrome, neurotoxicity, or infections can be managed by our physicians. The time that elapses from the administration of cells to discharge is usually shorter than 1 month.
After CAR T-cell therapy, you will need IVIG (immunoglobulin) treatment for up to 1 year. The number of CAR T-cells will be counted, the probability of insidious disease will be checked, and the B-lymphocyte count will be analyzed at monthly intervals. If a negative result is obtained in one of these three follow-up parameters, your treatment will be completed with allogeneic stem cell transplantation.
International trials demonstrate that total response can be >90% in Acute Lymphoblastic Leukemia and >80% in Non-Hodgkin Lymphoma patients. These figures are comparable to our data. Today, CAR T-Cell therapy is the most effective option available for patients with ALL and NHL resistant to second-line treatment. CAR-T immunotherapy provides these patients with the opportunity of a complete cure.