How a Match is Determined

In an allogeneic transplant, stem cells are collected from a donor and transplanted into the patient in an effort to suppress the disease and restore the patient’s immune system. The most important characteristic of these stem cells is their HLA (human leucocyte antigen) type. If donor and recipient have the same HLA-type, they are called HLA-identical and transplant with HLA-identical donors used to have the best success rates. About one of four among our siblings are HLA-identical, and the odds of being HLA-identical are very low for unrelated individuals. The use of large registries of unrelated donors – organized through the National Marrow Donor Program – allows the identification of HLA-identical donors for approximately 70% of Caucasians. Unfortunately, the percentages are much lower for patients of minority descent.

Some of our patients may undergo a Haplo-Cord Transplant, which is made available to patients who don’t have an exact match. Through this process, patients receive stem cells from a single cord blood unit combined with stem cells from a donor who is “haploidentical” to the patient. Others may undergo a double umbilical cord transplant or a haplo-identical transplant.

Identifying a close match between your HLA markers and your donor’s will reduce the risk that your immune cells will attack your donor’s cells or that your donor’s immune cells will attack your body after the transplant. Prior to receiving an allogeneic transplant, patients will have a blood sample taken to test their HLA type in order to find the best donor fit.

Examinations and Testing Requirements

Prior to being considered for a transplant, you will have many examinations and tests to undergo to make sure your health can be optimized prior to the transplant and to ensure you’re receiving the best clinical care throughout the process. These will likely occur within 30 days prior to your transplant and consist of the following:

• A complete history and physical exam with blood work
• A consultation with one of our social workers. This will be helpful in identifying social or emotional concerns, as well as providing physical support during the months ahead.
• Dental evaluation by a dentist or your physician will identify problems and develop a plan to solve them before, during or after your treatment.
• MUGA and/or Echo, special tests to evaluate your heart function.
• Chest x-ray
• Sinus x-ray
• Urine Test
• Pulmonary function test that evaluates how well your lungs work.
• A bone marrow biopsy and aspirate to assess the status of your disease. A bone marrow aspirate is a procedure in which an area on your hip is numbed and a small amount of bone marrow is withdrawn through a needle. A bone marrow biopsy is similar to a bone marrow aspirate except a small core sample of bone marrow is removed through the needle.
• CT scans (similar to a chest x-ray except more detailed) of your chest, possibly abdomen, pelvis and sinus or a skeletal survey (skeletal x-ray use to detect lesions or fractures).
• Blood will be taken to assess certain infectious disease markers, including HIV and hepatitis will be checked. You will be asked to consent for the HIV test. Other blood tests will also be collected looking at your blood counts and chemistries.
• Pregnancy test for premenopausal females.

Prior to Being Admitted

Your BMT Coordinator

Your BMT coordinator is your primary contact throughout the pre-transplant phase. The coordinator will organize your testing and stem cell collection (if required), facilitate the testing of potential donors, conduct your donor search (if needed), and work directly with your insurer to obtain the necessary approvals and/or authorizations. The BMT coordinator works closely with your physician to ensure that all testing is completed, and that the best donor source is selected for your transplant (should you need one). At the end of the first visit you will receive a Bone Marrow Transplant Educational Booklet (see link on right) with important information that you can read at your leisure.

Orientation Group

All transplant patients and caregivers are required to attend at least one Bone Marrow and Stem Cell Transplant Orientation Group. We encourage you to attend as many group sessions as you would like in order to feel comfortable before your transplant.

Dates and times for upcoming orientation groups are outlined below.

• Wednesday, January 17th at 4:00PM
• Monday, February 5th at 11:00AM
• Wednesday, February 28th at 4:00PM
• Monday, March 12th at 4:00PM
• Thursday, Match 29th at 11:00AM
• Wednesday, April 18th at 4:00PM
• Monday, May 14th at 11:00AM
• Wednesday, May 30th at 4:00PM

Location:

NewYork-Presbyterian Hospital/Weill Cornell Medicine
Greenberg Pavilion, 10th Floor
10 South Patient Lounge

For more information about the orientation groups and to RSVP, please contact Sarah Waxse, LCSW via email (smw9001@nyp.org) or by phone, 212-746-4952.

Figuring out Finances

The transplant process is a complex medical procedure. Our program offers financial coordinators who will work with you to minimize the expenses for yourself and your family by ensuring that a majority of the costs are covered by your insurance carrier. NewYork-Presbyterian Hospital accepts most major forms of insurance. The charges vary based on what type of transplant you are receiving.  Most patients spend at least three weeks in the hospital to receive high dose chemotherapy and stem cell infusion.

If you are using stem cells from a donor, the national marrow donor program or similar organizations will charge for identification of unrelated stem cell or bone marrow donors. The associated costs are for clearance of the donor, the collection of stem cells and their shipping. In most cases, these charges are covered by the transplant recipient’s insurance.

If we use your own stem cells for an autologous transplant, stem cells need to be mobilized and collected through a process called apheresis.

After transplant, particularly after allogeneic transplant, the recovery process can be lengthy. You will need to take many medications and will have frequent doctor’s visits.

Our financial coordinators will work with you every step of the way and will assist in collecting all of the necessary paperwork required from your insurance carrier, such as pre-transplant test results, assessment of response to previous chemotherapy, letter of medical necessity and physician forms. Key contact information can be found below:

BMT Financial Coordinator:
(212) 746-5415

Financial Assistance for Hospital Billing:
(866) 252-0101

Physician Assistance for Billing:
(212) 590-5710

Stem Cell Mobilization and Collection for Autologous Transplant Patients

Once your white blood cells recover, you are ready for stem cell collection. Your bone marrow transplant coordinator will call you as soon as you can begin. You will then be asked to come back in for apheresis collection, which is located in the Starr Building in room 326. Apheresis is a procedure in which your blood is withdrawn from the apheresis catheter (or from an arm vein in some cases) and passed through a machine to collect a portion of your blood called stem cells. The rest of the blood is then returned through the catheter (or into a vein in your other arm). The apheresis procedure will take between four to six hours to perform. If not enough stem cells are obtained, you may be required to undergo multiple apheresis procedures.

You may experience certain side effects from the procedure, which are similar to those involved in blood donation. These include: nausea, vomiting, fainting or dizziness, hematoma (accumulation of blood at the needle puncture site), seizures, blood loss, and infection. In addition, an anti-clotting substance (usually citrate) will be used to prevent your blood from clotting during the procedure, and potential side effects from the citrate may include muscle cramping, numbness, chilliness, tingling sensations, and a feeling of anxiety. In rare occasions, you may require a blood transfusion.

There are cases when a patient may not yet be ready to have a transplant per their physician’s recommendation, however, it would still be a good idea to collect your stem cells in the event you’ll need a transplant later down the line. The reason for this is because you want to collect and freeze your stem cells before they get more cancerous. If you have your stem cells collected when you’re in remission, those stem cells can be used for a transplant should you need one down the line.