Stem cell transplantation is a procedure for patients with certain cancers or whose bone marrow does not produce healthy blood cells. Bone marrow stem cells are crucial to our health because they produce the three types of blood cells that the body needs: 

  • Red blood cells, which carry oxygen to the body

  • White blood cells, which fight infection

  • Platelets, which help the blood clot

Certain diseases and the treatment of some cancers with high-dose chemotherapy or radiation therapy can damage a person’s stem cells. Transplantation, which replaces the damaged stem cells with healthy, functional stem cells, can be one of two types:

  1. Autologous: We collect your own cells from your bloodstream and store them for transplant.

  2. Allogeneic: We harvest healthy cells from a family member or unrelated donor.

Who can benefit?

Stem cell transplantation is the standard of care for patients with certain types of cancer and blood disorders. 

  • Acute and chronic leukemias

  • Aplastic anemia

  • Multiple myeloma

  • Non-Hodgkin and Hodgkin lymphoma

  • Myelodysplastic syndromes

  • Myeloproliferative disorders

  • Primary light chain amyloidosis

  • Sickle cell anemia

Stem Cell Transplant and Cellular Immunotherapy program

Our program is the only adult academic program of its kind in the Washington, D.C. region. This program gives patients access to life-saving treatment options not otherwise available in our region. Our specialists have extensive experience performing this complex procedure. 

We are also proud of our partnership with the John Theurer Cancer Center at Hackensack University Medical Center and the physicians and scientists of Georgetown University School of Medicine. Together, we are able to deliver comprehensive, advanced care to our patients.

Program features

  • Dedicated transplant specialists: Our physicians are full-time transplant specialists who have dedicated their entire careers to bone marrow and stem cell transplantation and to cellular immunotherapies. We offer all of the treatment options available today and can confidently recommend the optimal techniques and procedures for you. 

  • Experienced team: Our physicians have decades of experience performing transplantation procedures, making us one of the top transplantation teams in the region. We translate the latest research into results, leading to improved techniques and outcomes. We combine our experience with the expert team at MedStar Georgetown’s Lombardi Comprehensive Cancer Center, the only National Cancer Institute-designated cancer center in the Washington, D.C. region. 

  • Expertise with high-risk patients: Patients who may have been turned away from other programs—due to age, health, or other reasons—often find hope and treatment at our Stem Cell Transplant and Cellular Immunotherapy Program. We are confident in our ability to guide high-risk patients safely through the treatment and recovery process.

  • Holistic care: We know a sickness affects more than just your physical health. Our robust team consists of many different health care professionals, who are here to care for your physical, emotional, and social needs.

  • World’s largest marrow harvesting site: MedStar Health is home to the largest collection site for the National Marrow Donor program, a program started by the U.S. Department of Defense. This gives us an unmatched level of experience and expertise in cell collection. 

Transplantation procedures

We provide the full spectrum of care for our stem cell and cellular therapy patients. We want you to feel informed and prepared prior to your transplant. Our team will take the time to explain every step in detail and answer any questions you may have. 

We tailor your treatment plan for your needs, factoring in your age, general health, and specific condition. Our team will discuss the process for your individualized treatment with you.

Preparation

Your overall health contributes greatly to the success of your transplant. We want to ensure that you are in the best health possible before your procedure. 

Our pre-transplant coordinators and support staff will help guide you through the preparation phase, helping you lower your risk of complications and increase your chances for a positive, long-term outcome. They may recommend some exams or tests prior to your transplant, to treat existing infections and plan for your postoperative care. These include:

  • Baseline tests: We will run diagnostic tests prior to your treatment to give us a detailed picture of your current health status. Tests include imaging scans, a heart evaluation, and comprehensive laboratory testing. 

  • Dental exam: It’s important to treat any sources of infection. Your dentist may also recommend fluoride treatments to prevent decay.

  • Gynecological exam: Women are required to undergo a gynecological exam before transplantation to detect ongoing problems needing treatment. 

  • Dietary changes: During your transplant, you will meet with a dietitian to discuss your individual nutritional needs. 

  • Fertility planning: During consultation, your doctor will discuss fertility options with you and refer you to a fertility specialist or center, if appropriate. 

We will then begin preparing you for the actual procedure.

Stem cell collection

Stem cells must be collected from you (autologous transplantation) or your donor (allogeneic transplantation) for this treatment. We may collect cells from you, a relative, or an unrelated donor. 

The techniques are very similar for both the patient donating for personal use or the donor giving cells to be used by another person. Your physician will recommend collection of these cells either from the bone marrow or peripheral blood. 

MedStar Health has unique expertise in this area. We are home to the largest marrow and blood stem cell harvesting site for the National Marrow Donor Program in the nation. This high volume gives our team a superior level of experience and expertise in cell collection. 

Bone marrow collection

This procedure involves multiple needle aspirations from the hip bones in the back (posterior iliac crests). This procedure is performed in the operating room with anesthesia for the comfort of the donor. 

The procedure is about 1 hour in duration. The soreness after the procedure quickly resolves over the next few days after the collection.

Peripheral blood collection

Apheresis involves removing stem cells (or immune cells) from the blood. Patients and donors will first receive several days of a bone marrow growth factor to “mobilize” the stem cells from the bone marrow into the blood. 

The patient or donor will then donate blood using an apheresis machine. Apheresis requires placement of a needle into each arm for collection and return of the blood. A catheter, or central line, may be placed in order to collect the stem cells if the arm veins are not large enough for the needles. 

During apheresis, our team of dedicated nurses will monitor you for your comfort. Apheresis is typically performed as an outpatient procedure, and you may go home after the procedure is completed.

CAR T-cell therapy

Chimeric antigen receptor (CAR) T-cell therapy is an innovative treatment to fight cancer. CAR T-cell therapy is an immunotherapy that uses the patient’s own immune system, genetically modified to fight cancer cells. 

CAR T-cells are unique in that they can stay in the body for years and continue to circulate and kill cancer cells. Much like autologous stem cell transplantation, a patient's own T-cells are collected through a process called apheresis. 

MedStar Health is an authorized treatment provider for CAR T-cell therapy, including advanced gene therapy to treat B-cell acute lymphoblastic leukemia in children and young adults. In addition, patients have access to CAR T-cell therapy clinical trials. 

Our program is the only hospital in the Washington, D.C. metropolitan area to offer chimeric antigen receptor (CAR) T-cell therapy. CAR T-cell clinical trials are ongoing in the U.S. and commercially approved treatment is available. 

CAR T-cell therapy involves collecting immune cells from your blood, modifying them in a lab, and returning the modified cells to you via an IV infusion. The goal is to stimulate your immune system to more effectively target cancer cells and eliminate disease. 

The U.S. Food and Drug Administration has approved CAR T-cell therapy to treat adult patients with certain types of B-Cell Lymphoma that have not responded to other therapies or who have relapsed after two other kinds of treatment. 

What to expect during CAR T-Cell Therapy

Before treatment 

At your first visit, you will meet with your care team to: 

  • Determine if you are an appropriate candidate to receive CAR-T cell therapy. 

  • Discuss your treatment approach. 

  • Discuss the CAR T-cell therapy process, potential side effects, and outcomes. 

  • Understand the impact on your quality of life and day-to-day activities. 

  • CAR T-cell therapy begins with a process involving blood collection, to obtain immune cells needed for CAR-T cell manufacturing. 

  • Your blood will be collected by an Apheresis machine. The machine will sort your T-cells from your blood. The non-T-cells are returned to your body. This procedure can take up to six hours and is performed on an outpatient basis. 

  • Your T-cells are then sent to a lab to be genetically modified. The chimeric antigen receptor, or CAR, is attached to the T-cells. The CAR(s) grow and expand in the lab and are ready to be re-infused into your body in approximately three weeks. 

During CAR T-Cell Therapy 

  • You will receive chemotherapy to prepare your body to receive the modified CAR T-cells. Your chemotherapy regimen may be given on an outpatient or inpatient basis. 

  • Your CAR T-cells will be infused back to you after receiving chemotherapy. You may be admitted to the hospital to receive CAR T. 

  • After receiving CAR T-cell therapy, you will be closely monitored by your care team at MedStar Georgetown. Depending on the type of CAR T given, some patients may remain in the hospital for two weeks after their CAR T infusion. 

  • The biggest side effects of CAR T-cell therapy include the development of cytokine release syndrome (CRS) and neurotoxicities. CRS syndrome means that your body is setting up an immune response and substances called cytokines are released. Signs of CRS include lowered blood pressure, fever, rash, chills, and abnormal laboratory values. If patients experience severe side effects after CAR T-cell therapy, they may require care in an intensive care unit (ICU). 

  • Neurotoxicity signs include dizziness, forgetfulness, and seizures. Some patients may experience difficulty in speaking or writing. Your doctor and clinical team will monitor you carefully for abnormal symptoms and signs of neurotoxicity. 

After CAR T-CELL treatment

Treatment does not end after CAR T-cell therapy. You will require monitoring over a period of years to ensure that your cancer does not come back. 

You will still need to see your primary oncologist for regular monitoring and check-ups. You will continue to see your Cellular Immunotherapy care team at Medstar Georgetown. 

MedStar Georgetown is an authorized Yescarta® treatment site and is an authorized site for Kymriah. 

MedStar Georgetown is FACT accredited for IEC (Immune Effector Cell Therapy). 

Our team multidisciplinary team is dedicated to your care. Your Cellular Therapy team care includes: 

  • A dedicated nurse coordinator 

  • A dedicated social worker 

  • A cellular therapy physician 

  • Trained and experienced nursing staff 

  • Financial coordinator 

Am I a candidate?

You may be wondering if you or a loved one is a good candidate for a stem cell transplant or cellular therapy procedure. Only your healthcare team can make the final determination. Our expert transplantation team works with you to determine your candidacy. The evaluation process includes many tests which may include: 

  • Thorough physical examination and review of your medical history

  • Blood tests

  • Imaging scans, including chest X-rays and computed tomography (CT) scans

  • Tests to check your heart, lung, and other organ functions

  • Bone marrow biopsy (removing a small piece of your bone marrow for analysis), which gives us a deeper understanding of your condition

  • Psychosocial evaluation

Becoming a patient

You may begin the process by either:

  • Referring yourself directly to our program by calling 202-444-3736

  • Having your hematologist/oncologist refer you to one of our transplant physicians

After the initial phone call, we will advise you about your next steps. In preparation for your cellular therapy or stem cell transplant consultation, be prepared to: 

  • Bring your insurance card and any referral forms or pre-certification information that your insurance carrier requires.

  • Bring a family member or friend to your first consultation. 

Once we have determined that you are eligible for transplantation or cellular therapy, we will discuss the following with you: 

  • The type of transplant you will have: autologous (using your own cells) or allogeneic (using a donor’s cells)

  • How to prepare for a bone marrow or stem cell transplant

  • What to expect during your transplant or CAR T-cell therapy 

Our team

Our team consists of highly specialized physicians, nurses, and other healthcare professionals:

  • Pre-transplant and cellular therapy coordinators, who can help you manage appointments, paperwork, and all of your pre-transplant needs 

  • Dedicated inpatient and outpatient nursing staff, with experience caring for stem cell transplant and cellular therapy patients 

  • Insurance coordinator

  • Social worker

  • Dietitian

Every member of our team is committed to providing comprehensive and compassionate care to our patients. We have one of the few dedicated transplant programs in the region, giving our team a high level of expertise and experience. Our care doesn’t begin or end with the procedure—we are with you from the moment you walk through our doors and continue to provide services throughout your treatment and follow-up care.

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