Bone Marrow Transplants and Treatment of Hematological Disorders at Sheba Medical Center
Hematology is the medical discipline that deals with the diagnosis and treatment of disorders of the blood, including blood production and composition problems. At Sheba Medical Cancer Center, our Hematology Clinic treats many forms of blood malignancy. We always take a comprehensive view of cancer treatment, including collaboration among oncologists, hematologists, and radiation oncologists, in order to provide our patients with tailor-made medicine.
Some of the hematologic malignancies treated at Sheba Medical Cancer Center are outlined below.
Acute Lymphocytic Leukemia (ALL) and Chronic Lymphocytic Leukemia (CLL)
Leukemia is a condition in which the body’s white blood cells, agents of the immune system, are quickly and abnormally produced. These abnormal white blood cells do not function properly and interfere with the production of other blood cell types, like platelets and red blood cells.
ALL is a disease with a rapid onset. Although it can certainly be found in adults, ALL is also the primary form of childhood leukemia. Symptoms include flu-like responses like chills, fevers, and sweats. ALL patients may also notice weight loss, headaches, a swollen liver or spleen, bleeding gums, and generalized weakness and fatigue.
The risk factors for ALL include radiation exposure, having undergone chemotherapy in the past, family history and Down syndrome. Generally, though, there is no way to effectively prevent leukemia for certain.
Treatments for ALL vary depending on the patient’s condition, blood cell levels, and stage of the disease. Traditional chemotherapy, radiation therapy, targeted chemotherapy, and stem cell transplants may all be employed in the fight against the disease.
CLL differs from ALL in several key ways. CLL generally develops more slowly than ALL and symptoms may not become apparent for several years. The abnormal white blood cells in CLL are mature, rather than the abnormal juvenile cells found in ALL. Also, CLL tends to affect adult patients much more frequently than children.
Chronic Myelogenous Leukemia (CML)
CML is a rare disease in which too many white blood cells are produced by the bone marrow. This in turn leaves little room for other blood cell types, like red blood cells and platelets. CML is very slow to develop and is normally seen in adults over 50. Most patients also carry a genetic mutation called the Philadelphia chromosome. This mutation is not hereditary.
The symptoms of CML include weight loss, fatigue, rib pain, and fever. It is possible for individuals with CML to be asymptomatic, showing no signs of the disease. Risk factors for CML are high dose radiation exposure and age as most patients are over 50.
Possible treatments for CML include both conventional and targeted chemotherapy, therapy with biologic drugs, and chemotherapy in conjunction with stem cell transplants. Also, infusions of lymphocytes from a compatible donor are a therapeutic option.
Non-Hodgkin Lymphoma (NHL)
NHL is a cancer of the lymphatic system. It is not a single disease but rather a constellation of similar diseases. It typically develops in the lymphatic tissues and lymph nodes and can be either aggressive or indolent, progressing slowly. NHL is divided into three major types.
B-cell lymphoma begins in the B lymphocytes, cells that produce antibodies in the immune system, and makes up about 85% of all NHL cases. T-cell lymphoma affects T lymphocytes, while NK-cell lymphoma involves natural killer cells, responsible for attacking cancer cells and cells infected by viruses.
The risk factors for NHL are not yet clearly understood. It has been theorized that exposure to certain pesticides and other chemicals may increase the chance of developing NHL. Treatment for NHL is dependent upon the type and subtype of the disease and generally includes chemotherapy and radiation therapy.
Hodgkin lymphoma is a cancer of the lymphocytes, a type of white blood cell, and the bone marrow, where blood cells are produced. It is typically very treatable and is characterized by abnormal lymphocytes, which tend to gather and form masses in the lymph nodes and other areas of lymphatic tissue. If this continues, there is eventually no space for normal lymphocytes and other blood cells.
The disease is also distinguished by the presence of Hodgkin cells and Reed-Sternberg cells, types of giant cells that are very abnormal. There is still research ongoing into the risk factors for Hodgkin lymphoma, but people testing positive for mononucleosis appear to have three times the risk of developing Hodgkin lymphoma compared to the general population. Also, some families develop the disease more frequently than others. Treatment usually consists of chemotherapy, radiation therapy, or a combination of both.
Bone Marrow Clinic
The Bone Marrow Clinic at Sheba Medical Cancer Center is set up to provide total care and world-class medicine with a personal touch for patients and donors. To date, over 2,000 bone marrow transplants have been performed at Sheba. The facility cares for patients both before and after the transplant and is equipped with 17 beds, serving 4,500 patients each year. Bone marrow transplant treatments and stem cell therapies are provided for patients with leukemia, lymphoma, and certain autoimmune disorders.
Bone marrow transplants fall into several categories depending on the source of the donor marrow. Autologous transplants are taken from the patient’s own stem cells, usually from peripheral blood, which is then frozen and preserved. This type of transplant is used when a suitable donor cannot be found or if necessitated by the patient’s condition.
Allogenic transplants are performed with donor tissue from a genetically suitable family member. The source may be peripheral blood, cord blood, or bone marrow. An allogeneic transplant may also be performed from an unrelated donor, again via bone marrow, cord blood, or peripheral blood. Another option is a mismatched allogeneic transplant. In this case, there is only a 50% match from a related donor, with more compatibility needed if the donor is unrelated. The stem cells are sourced from peripheral blood and refined before transplantation to compensate for the lack of a complete match.
There our staff member:
- Prof. Arnon Nagler is a specialist in internal medicine, hematology, and bone marrow transplantation, who completed a fellowship and advanced training at Stanford University in the United States. Dr. Nagler has particular expertise in umbilical cord blood banking and stem cell harvesting.
- Dr. Avichai Shimoni is a specialist in hematology, internal medicine, and bone marrow transplantation. He has completed advanced training at MD Anderson Cancer Center at the University of Texas.
- Pediatric Leukemias, Solid and Brain Tumor Research Laboratory
Our research here is focused on the treatment of childhood cancer patients, particularly those with aggressive and difficult to treat cancers. We take a comprehensive approach, combining clinical and basic research with a multidisciplinary team, including members of the Department of Pediatric Hemato-oncology. We have numerous ongoing research projects, including investigations into genetic markers of pediatric brain cancer, hematological malignancies, stem cell research, and research into drugs for the treatment of brain cancer. The laboratory is headed by Prof. Amos Toren, a director of both the Pediatric Hemato-Oncology Department and the Stem Cell Transplant Unit.
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