BMT Program

BMT is a term that refers to the use of immature cells (stem cells) derived from the bone marrow or blood as part of the therapy of cancer and some other serious medical conditions. The stem cells used in BMT can be obtained from the patient (autologous BMT) or from a donor (allogeneic BMT).Which type of BMT is performed will depend largely upon the patient's diagnosis and clinical history.
The stem cells used are ultimately derived and may be collected directly from bone marrow; although most commonly, they are collected from the blood using a process called "mobilization." Mobilization involves the administration of medications that temporarily move some of the bone marrow stem cells into the blood stream where they can be more easily collected. When stem cells are collected in this manner, the procedure is usually not painful and general anesthetic is not necessary. However, a catheter accessing a central vein is usually needed.
For both autologous and allogeneic BMTs, the patient receives special preparative treatment for approximately 1-6 days. This is also called the "conditioning" regimen. For autologous transplants the conditioning regimen is administered after completion of the mobilization and cell collection phase. For allogeneic transplants the conditioning regimen is often administered to the patient while the donor is undergoing mobilization/cell collection. The conditioning regimen provides anti-cancer therapy and for allogeneic BMT also prevents rejection of the donor's cells. This conditioning regimen caused the blood counts to be severely reduced for several days. The period during which the patient's white blood cell count is very low is usually called the "neutropenic" period. This is a time during which the patient is highly susceptible to infections and must be monitored closely.
Once the conditioning regimen is completed, the stem cells are infused into a large vein like a blood transfusion. This is usually done through a special venous cathether. These cells find their own way to the bone marrow and typically start to manufacture blood cells there a few days later. This results in recovery of the white blood cell count typically by about 10-15 days after the stem cell infusion. During the neutropenic period the patient usually requires blood and platelet transfusions and also usually receives prophylactic antibiotics to prevent infection. Once the patient's white blood cell count is recovered the risk of infection decreases. However, the patient may still be susceptible to unusual infections for some time thereafter and continued precautions/medications may be necessary.
Generally, patients undergoing an allogeneic transplant are at risk for infections for longer than patients undergoing allogeneic transplantation. They are also susceptible to immune complications like graftversus- host disease (GVHD) and rejection of the graft which typically do not occur after autologous transplants. Thus, patients undergoing allogeneic transplants usually require longer periods of close monitoring and also take medications which prevent infection, GVHD and graft rejection for several months (and occasionally longer).
Most patients eventually recover from their transplant and manage to come off all medications - returning to a normal quality of life. Also, as BMT is a potentially curative treatment for many conditions, we expect many patients to achieve a normal life-span. Patients continue to be monitored for some time for possible recurrence of their cancer and also for the development of second cancers. Our patients are often referred from outside oncologists or other specialists. Although our patient's care is primarily the responsibility of the BMT team during the transplant phase of their treatment, we work closely with your referring physician (if you have one) to manage your long term care.