Dr. Miguel-Angel Perales is Chief of the Adult Bone Marrow Transplant Service at MSK.
Patients with leukemia, lymphoma, multiple myeloma, and myelodysplastic syndrome often need a stem cell transplant (also known as bone marrow transplant, or BMT) to treat their blood cancer.
Stem cell transplants are extremely complex because patients need to have their diseased blood cells wiped out before they can be replaced with new, healthy cells. This is done using chemotherapy, either alone or in combination with radiation therapy. The replacement cells can be from the patient (called an autologous transplant) or from a donor (called an allogeneic transplant).
Stem cell and bone marrow transplants don’t just require an expert medical team. They also require strong emotional support for patients, who often spend long periods of time in the hospital and must manage many side effects.
The year 2023 marks the 50th anniversary of the first-ever transplant of bone marrow from a donor to a patient who was not related, which was performed at Memorial Sloan Kettering Cancer Center (MSK). The achievement was groundbreaking because it opened up the possibility for patients to find donors outside their families, greatly expanding the use of these potentially lifesaving treatments.
Here, medical oncologist Miguel-Angel Perales, MD, Chief of the Adult Bone Marrow Transplant Service, explains why MSK’s BMT program has continued to be a leader in the field of transplantation over the past 50 years. Along with his role at MSK, this year Dr. Perales is serving as president of the American Society for Transplantation and Cellular Therapy.
1. MSK has the largest BMT program in the New York City area.
In addition to having by far the biggest and most experienced BMT program in the New York metropolitan area, MSK has one of the largest in the country. “In 2022, our adult BMT program performed 545 transplants — the most we’ve ever done,” Dr. Perales says. “We also treat many children and teenagers through our MSK Kids pediatric BMT program. Since their beginnings, the adult and pediatric BMT programs have performed over 10,000 transplants. And our Cellular Therapy Service offers treatments like CAR T cell therapies.” These treatments use a patient’s own immune cells to recognize and fight the cancer.
2. MSK has experts focused solely on stem cell and bone marrow transplants.
“Another reason we are recognized as leaders in the field is that everything we do is a team effort. We say this so often that it sounds like a cliché, but it’s true,” Dr. Perales says. “We have many care providers whose only focus is people receiving BMTs and cell therapies.”
Members of the BMT team work with many other experts across the hospital. “I don’t think there’s a single department within the hospital that BMT doesn’t touch,” he adds. “In many ways, the strength of this program is the strength of the whole institution.”
- The BMT team includes doctors who focus primarily on patient care as well as those who focus more on clinical or laboratory research.
- The team also includes physician assistants, nurse practitioners, and registered nurses who work exclusively in the BMT program. They form close, personal connections to patients going through this therapy.
- Clinical care coordinators, who are also nurses, focus on getting patients ready to have their transplants.
- The BMT program has a dedicated group of pharmacists, as well as experts in diet and nutrition.
3. MSK has specialists caring for the other medical needs of people undergoing stem cell transplants.
The BMT team relies on many members of MSK’s Division of Subspecialty Medicine — doctors who focus on providing general medical care to people being treated for cancer.
BMTs can affect many systems in the body. MSK has pulmonologists, gastroenterologists, cardiologists, dermatologists, kidney specialists, and others who have specialized expertise in the challenging complications that can arise around BMTs. These experts care for patients before, during, and after their transplants.
“We work especially closely with MSK’s infectious diseases experts,” Dr. Perales notes, “including those who see only BMT and leukemia patients.” Because of the type of chemotherapy used for blood cancers, patients may be severely immunocompromised. Infections are always a big concern.
4. MSK has unique programs that may not be available at other hospitals.
MSK has a clinic dedicated to treating graft-versus-host disease, a serious complication of BMTs that use donor cells. This side effect occurs when the donor’s immune cells attack healthy tissues in the recipient. The clinic is co-led by hematologic oncologist Doris Ponce, MD, MS; pediatric hematologist-oncologist and BMT specialist Andrew Harris, MD; and dermatologist Alina Markova, MD.
Also, we have options for the many people who may not find a matched donor. It’s especially a challenge for people who have southern European, Asian, African, Hispanic, Middle Eastern, or mixed ethnic backgrounds. MSK’s Cord Blood Transplant Program uses stem cells from the umbilical cords of newborns, which have been donated to a cord blood bank. This approach has saved many patients at MSK.
5. MSK’s research strives to improve BMTs and make them more accessible.
MSK has nationally recognized research efforts focused on new ways to make transplants more effective for more people. One major challenge is controlling the disease well enough so patients are healthy enough to undergo a transplant. “We are getting better at doing that, by using newer chemotherapies as well as targeted therapies and immunotherapies,” Dr. Perales says.
Efforts also focus on making transplants available to everyone who needs them. At the American Society of Hematology meeting in December 2022, a team led by hematologic oncologist Boglarka Gyurkocza, MD, and reported on how MSK works to overcome barriers to offering this treatment to patients.
In addition to using cord blood transplants, MSK has developed other ways to allow people without a perfectly matched donor to receive transplants from a family member or unrelated donor who is only a partial match. This alternative donor program is led by BMT specialist Brian Shaffer, MD. “When I consult with a patient, one of the first things I say to them is, ‘I am confident we will find you a donor,’ ” Dr. Perales says.
6. MSK treats rare cancers with stem cell transplants, too.
While BMTs typically treat common blood cancers like leukemia, lymphoma, multiple myeloma, and myelodysplastic syndrome, they can also treat less common disorders, including systemic amyloidosis and central nervous system (CNS) lymphoma. MSK has experts who specialize in treating these rare cancers with transplants.
The MSK Kids team also uses BMTs to treat children with certain inherited noncancerous blood disorders. “We expect to expand care to adults with inherited disorders as well, now that promising treatments like gene therapy for sickle cell anemia have received approval from the U.S. Food and Drug Administration,” Dr. Perales notes.
7. MSK offers BMT care at many locations outside of Manhattan.
People having BMTs can receive some of their care at our regional sites, including MSK Commack and MSK Nassau on Long Island and MSK Westchester. It will soon be available at MSK Monmouth in New Jersey as well.
MSK’s newest location in Brooklyn, Memorial Medical Care, PC, also houses dedicated blood cancer treatment and bone marrow transplant experts. “We are excited that we have been able to make ourselves more available to patients who live in New York City but find it difficult to travel into Manhattan,” Dr. Perales says.
8. MSK has been a leader in providing innovative BMT treatments for 50 years.
In 1973, MSK pediatric oncologist Richard O’Reilly, MD, pioneered the development of the first bone marrow transplant for a pediatric patient without a sibling who was a proper match. The patient received bone marrow from an unrelated donor who was found to be a match. This type of transplant has dramatically expanded treatment options for patients of all ages with blood cancers — not just at MSK, but worldwide.
