Tsiporah B. Shore, MD
Stem cell transplantation has dramatically evolved over recent years to include more patients with hematologic malignancies, particularly in multi-ethnic populations, according to Tsiporah B. Shore, MD.
“Living in a very multi-ethnic, multi-racial area like New York and the whole Tri-state area, we have to accommodate the needs of many ethnic and racial groups,” said Shore.
With the addition of novel approaches such as haplo-cord and haploidentical transplants, an increasing number of patients are able to receive this necessary treatment, she adds.
In an interview during the 2017 OncLive®
State of the Science SummitTM
on Hematologic Malignancies, Shore, associate director of the Bone Marrow Transplant Program, Weill Cornell Medicine/NewYork-Presbyterian Hospital, discussed some of these newer advancements related to stem cell transplantation and the challenges with including patients in ethnic populations.
OncLive: Can you provide an overview of your lecture on stem cell transplantation?
I highlighted that stem cell transplantation is a very important procedure that should be available for everyone. Looking at the unrelated registry, or even within families, there are very limited donors for many ethnic populations. We have to do something about that so that transplants are available to those people, even when donors are not available in the registry.
We have come up with different ways to do that in the transplant community. In our center, we pioneered a new method called the haplo-cord transplant. In addition, we do cord transplantations and haploidentical transplantations. Because those options are fairly new and different than what we had 5 years ago, we're able to find donors for almost everyone.
That is so important—to be able to bring this technology to everyone. We live in a very multi-ethnic world, we have pioneered some of these things, and we have gotten very good at it. We have saved many lives by using these approaches. We work with a very multi-ethnic, multi-racial diverse group of physicians, nurses, and other transplant personnel and we really do pay attention to the ethnic needs of our patients, as well as their medical needs.
Can you discuss these newer transplant approaches in more detail?
The one that we pioneered at Weill Cornell Medicine is the haplo-cord protocol. What that means is we combine a haploidentical donor with a cord. What that allows us to do is, with the haplo donor, we are usually able to find a sibling, a parent, or a child that can serve as the haplo donor—because almost everyone has a sibling, a parent, or a child. They will be half of a match. Even when we can’t find that within a family, we can find half of a match in the registry—even when we can’t find a full match.
Then, we combine that with a cord. There are many cords around the world, and cords don’t have to be perfectly matched. And, they are easily available. Therefore, we can combine the haplo and the cord. When you combine them in this way, the haplo grows faster than the cord, so the haplo engrafts quickly and allows us to shorten the time to engraftment so patients can get less infections. The cord grows later on, and it is a better match than the haplo, which is half of a match. Then, the cord will eventually take over and the body won’t need the haplo anymore. When we did need it, it was available. That protocol has really done very well in our hands.
How do patients typically tolerate stem cell transplantation?
There are obviously 2 kinds of stem cell transplant. There is the kind where you use your own stem cells and the one where you use it from some sort of donor. In the presentation, we targeted racial and ethnic minorities, and that is specifically to discuss what happens in the type of transplant where you have a donor compared with your own cells.
When you have a donor, there are many possibilities for problems, from transplant all the way to infections, drug side effects, the period of pancytopenia where you might need transfusions, prophylaxis for various infections and, ultimately, we worry about graft-versus-host disease (GVHD), which is a reaction of the donor cells against the recipient. That can be either acute or chronic.
Our program has eliminated a lot of GVHD by using in vivo T-cell depletion. We have very little chronic GVHD in our program because of that, and we use that for almost all of our allogeneic stem cell transplants; it is some sort of in vivo T-cell depletion. It is pretty standard at our center, and we have not seen problems with relapse rates. One can get slightly more viral infections.