Hematopoietic Transplantation

Lifesaving Bone Marrow and Stem Cell Transplants

More than a million lives have been touched by Fred Hutchinson Cancer Center’s pioneering work in bone marrow transplantation, which began in the late 1960s. Dr. E. Donnall Thomas and his colleagues discovered a way to treat advanced leukemia by eradicating malignant white blood cells in the bone marrow using high doses of chemotherapy and radiation, and then replacing them with healthy donor cells. This revolutionary approach was the first definitive and reproducible example of the human immune system’s potential to eliminate cancer, and it earned Thomas a Nobel Prize in 1990.

Thomas and other Fred Hutchinson Cancer Center scientists spent the ensuing decades improving bone marrow transplantation —also known as blood stem cell or hematopoietic cell transplantation — to make the procedure safer and available to more patients. Today, thousands of patients around the world are cured every year thanks to modern forms of transplantation, which are used to treat dozens of diseases besides leukemia.

Harnessing the Immune System

Transplantation innovations developed at Fred Hutch include the “mini-transplant,” which requires a minimal dose of radiation and can be an alternative for patients who are unlikely to tolerate a traditional transplant. Our researchers have also played a key role in the development of the national marrow donor registry, conducted foundational research on donor-patient matching and made critical innovations in supportive care. For certain diseases, these advances have increased survival rates from zero to upwards of 90 percent. And our transplantation research offered the first definitive proof of immune cells’ power to cure cancer, kick-starting the now-burgeoning field of immunotherapy. Our research continues to advance the leading edge of transplantation and cellular therapy. 

Preventing and Treating Graft-vs.-Host Disease

We are developing new ways to prevent and treat graft-vs.-host disease, in which transplanted donor immune cells attack the patient’s healthy tissues. For example, we are testing new pre-transplant drug regimens that might lower risk; filtering out certain risky cells before transplant; and developing targeted drugs that could shut down harmful immune reactions before they get out of hand.

Improving Transplant Safety

A bone marrow or blood stem cell transplant is a potentially life-saving treatment, but it comes with potentially life-threatening risks. Transplant-associated mortality remains significant due to a variety of complications. Many researchers at Fred Hutch are aiming to improve transplant safety. They include Dr. Effie Wang Petersdorf, who studies how genetic factors influence the success of transplants and ways to improve matches between patients and unrelated donors. Dr. Filippo Milano and his colleagues have studied the use of umbilical cord blood for transplants in leukemia patients without a traditional donor match, finding better outcomes than with an unrelated donor in some settings. Numerous Fred Hutch researchers are developing lower-toxicity methods for preparing, or conditioning, patients for transplantation, such as a targeted form of radiation called radioimmunotherapy. And Fred Hutch had the world’s first program dedicated to addressing infectious complications of bone marrow transplant — which can include cytomegalovirus, influenza, pneumonia, herpes zoster and fungal infections — and our infectious-disease innovations continue to save lives.

Ensuring Quality of Life After Transplant

The dozens of Fred Hutch researchers who are investigating ways to help transplant survivors include Dr. Eric Chow, who studies cardiovascular disease risk factors in transplant survivors, and Dr. Rachel B. Salit, who investigates ways to decrease relapse risk and improve long-term quality of life. In 2018, Fred Hutch researchers published the largest-ever study of the well-being of informal caregivers for blood stem cell of bone marrow transplant survivors.

Our Long-Term Follow-Up program provides lifelong monitoring and care of patients following a bone marrow or stem cell transplant. Researchers in this program work in partnership with patients’ doctors to resolve medical problems and gather information for research. This information is used to develop improved strategies for preventing and treating long-term effects of transplantation and to educate patients about post-transplant problems.

Left: Brad Edmison and Laurel Joncas-Schronce in the Boeckh Lab. Right: Shalynn Flavell, who had a bone marrow transplant at Fred Hutch in 1991, at age 22.
Left: Brad Edmison and Laurel Joncas-Schronce in the Boeckh Lab. Right: Shalynn Flavell, who had a bone marrow transplant at Fred Hutch in 1991, at age 22.

Photos by Robert Hood / Fred Hutch (left) and courtesy of Shalynn Flavell (right)

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