Bone marrow / stem cell transplantation for blood cancer treatment in Germany

Bone marrow and stem cell transplantation for blood cancer treatment in Germany may be the last chance for some patients suffering from lymphoma or leukemia.

Universal building blocks are constantly produced formed in our bone marrow.

These are stem cells that can transform into any other mature blood cells.

In rare genetic conditions and some cancers such as leukemia or lymphoma, these “factories of life” are directly affected.

To cure such patients, German oncologists successfully use complex multi-stage treatment called blood stem cell transplantation (Transplantation von Blutstammzellen).

First, doctors completely destroy the diseased bone marrow with high doses of chemo or radiation – this is called conditioning. At the second stage, pre-prepared normal stem cells are administered to the patient, “rebooting” his hematopoiesis.

The cost of such treatment is up to 100 000 euros, because patients will need large doses of expensive drugs, special room to stay after conditioning, numerous laboratory tests, etc.

In some cases, blood stem cells are obtained from the patient himself during remission. But sometimes this is impossible, so doctors have to look for a suitable donor in national banks.

Blood stem cells biology: ancestors of everything

The main blood components are produced in the bone marrow.

Without blood stem cells, people cannot survive for long – these universal precursors provide us with platelets for blood clotting, leukocytes to protect against infections and cancers, red blood cells to breathe. Mature blood cells have a limited lifespan. Bone marrow constantly provides several billion recruits for this army. Every day, our body replaces old red blood cells, leukocytes, and platelets.

Being the only “blood factory” in the human body, the bone marrow is dispersed throughout the different parts of the skeleton for additional safety. Its workshops operate in the ribs, sternum, spine column, pelvic bone, thighs, skull, shoulder blades, and even the collarbone.

In smaller quantities, stem cells are found in the peripheral blood. To collect them from there in sufficient quantities, a complex procedure with special medication stimulation is necessary.

Indications for bone marrow & blood stem cell transplantation in Germany

Despite the technical complexity, risk and high cost, this procedure is vital for seriously ill people with oncohematological pathologies.

The following are the diagnoses for which stem blood cell transplantation has been approved by the German health authorities:

• Acute lymphoblastic leukemia
• Acute Myeloid Leukemia
• Beta thalassemia major
• Chronic lymphoblastic leukemia
• Chronic Myeloid Leukemia
• Immunodeficiency (including SCID)
• Fanconi Anemia (FA)
• Hodgkin's lymphoma
• Myelodysplastic syndromes (MDS)
• Non-Hodgkin's lymphoma
• Paroxysmal nocturnal hemoglobinuria
• Plasmacytoma (multiple myeloma)
• Polycythemia vera
• Primary myelofibrosis
• Sickle cell anemia

More information can be requested from the German Bone Marrow and Blood Stem Cell Transplantation Association (Die Arbeitsgemeinschaft für Knochenmark- und Blutstammzelltransplantation).

Consequences of chemotherapy and radiation therapy

Rapidly dividing cells are most sensitive to cytostatics and radiotherapy used to treat cancer. On the one hand, these are malignant cells for which treatment has been prescribed. On the other hand, these are the mucous linings and bone marrow.

How serious is this side effect?

It all depends on the dose and duration of toxic effects.

With radiation therapy, the effects depend on whether the bone marrow (the bones listed above) are exposed to radiation.

Fortunately, the vast majority of patients recover quickly after short-term suppression of the bone marrow. Physicians usually observe transient anemia, leukopenia and thrombocytopenia, which are completely reversible. Leading German hospitals use special cancer treatment protocols that minimize the negative impact of therapy on healthy stem cells.

However, hematologic cancer therapy is risky, requiring high doses of cytostatics. If standard options do not stop the disease, the destruction of the bone marrow and stem cell transplantation remains the only chance. The most dangerous part is the destruction of the bone marrow.

After conditioning, the body is left alone with numerous threats. Bleeding, minor infections from accidental contact – all this can kill a weakened patient in a couple of days. That is why a person should stay in a specially equipped ward under 24/7 monitoring. All contacts with other people are strictly limited.

It is important to introduce new stem cells as soon as possible.

Depending on the disease, German doctors use pre-prepared own cells or donor material.

There is a problem to find a donor who “matches” 100%.

Bone marrow & blood stem cell transplant centers in Germany

Several dozen oncohematological clinics and specialized departments of well-known hospitals throughout Germany are ready to offer this complex and responsible procedure to their patients, including medical tourists. We have listed some of them below.

The most famous bone marrow & blood stem cell transplant centers:

• Asklepios Clinic in Hamburg (Asklepios Klinik St. Georg)
• University Hospital Hamburg-Eppendorf (Universitätskrankenhaus Hamburg-Eppendorf)
• University Hospital Charité in Berlin (Charité-Universitätsmedizin)
• Helios Clinic Berlin-Buch in Berlin (Helios-Klinikum Berlin-Buch)
• University Hospital Erlangen (Universitätsklinikum Erlangen)
• University Hospital of Munich - LMU (Klinikum der Universität München)
• Nuremberg Hospital South (Klinikum Nürnberg Süd)
• University Hospital Aachen (Universitätsklinikum der RWTH Aachen)
• University Hospital Heidelberg (Universitätsklinikum Heidelberg)
• Rechts der Isar Hospital in Munich (Klinikum rechts der Isar der TU München)
• University Hospital Tübingen (Universitätsklinik Tübingen)
• Stuttgart Hospital - Katharinenhospital (Klinikum Stuttgart Katharinenhospital)
• University Hospital Freiburg (Medizinische Universitätsklinik Freiburg)
• Robert Bosch Hospital in Stuttgart (Robert-Bosch-Krankenhaus)
• University Hospital Dresden (Universitätsklinik Dresden)
• St. Johannes Hospital Dortmund (St. Johannes Krankenhaus)
• University Hospital Essen (Universitätsklinikum Essen)
• University Hospital Frankfurt (Universitätsklinikum Frankfurt)
• University Hospital Jena (Universitätsklinikum Jena)

Detailed information about the clinics is available in the German National Bone Marrow Donor Registry (Zentrales Knochenmarkspender-Register für die Bundesrepublik Deutschland, ZKRD).

Possible sources of bone marrow / blood stem cells for cancer treatment

Technically, blood stem cells must be transferred directly to the bone marrow, the place of their production. Another option is a special form of blood transfusion, before which doctors force stem cells to migrate from the bone marrow into the blood using special medicines.

In the first case, we are talking about bone marrow transplantation (Knochenmarktransplantation), in the second case method is called peripheral stem cell transplantation (Stammzelltransplantation).

German hospitals practice both methods for cancer treatment, but the second option is less stressful for the donor (painful bone marrow extraction is not required).

Studies show that hematopoiesis peripheral cell donors recovers faster than bone marrow donors. But the choice of a particular method depends on the situation.

Umbilical cord blood: alternative source of stem cells?

In German cancer centers, the umbilical cord blood of newborns as a source of stem cells plays relatively minor role, because this is a scarce biomaterial. It really contains a lot of valuable cells. Unlike adult donor blood or bone marrow, umbilical cord blood of newborns doesn't have age-related changes. From a biological point of view, it's perfect.

Umbilical cord blood is better tolerated by recipients, but the amount of material is usually insufficient. As a result, the patient will need more time to fully recover from cancer treatment.

Frequently asked questions about the treatment

Allogeneic procedure or autologous?

Transplantation from another person is called allogeneic. If the patient offers his own bone marrow or peripheral blood cells during remission of the disease, this procedure is called autologous. The choice of method depends not only on the patient's desire: German oncologists take into account a variety of clinical factors, including the cancer type, state of health, availability of a closely related donor and much more.

Autologous umbilical cord blood is available only if blood was taken for storage from you at birth. Thus, almost all such transplants are allogeneic, that is, they require a suitable donor from the bank.

What means the patient conditioning (Konditionierung)?

Conditioning is the prior destruction of the bone marrow by chemotherapy or radiation. The purpose of the procedure is to completely destroy the pathological hemopoietic tissues. Before allogeneic transplantation, conditioning must “turn off” the recipient's immunity in order to avoid rejection of the donor biomaterial. High-dose chemotherapy or radiation is usually used for this purpose. Depending on the clinical situation, additional drugs are prescribed to suppress cancer or alleviate side effects.

Who can become a blood stem cell donor?

The search for a donor usually starts from the close relatives of the patient. However, not all patients who require transplantation of allogeneic (donor) blood stem cells, find a suitable donor inside the family circle. National and international (European) databases allow them to find a non-related donor.

Thanks to an advanced donation system, German clinics are able to find the necessary biomaterial in a timely manner. Every healthy adult between the ages of 18 and 55 has the right to donate cells.

Among exclusion criteria are some chronic diseases (including infections). Modern technologies for diagnosing and assessing the quality of biological material guarantee the safety of tissue taken from German banks. Every year bone marrow & blood stem cell transplantation is becoming more reliable and affordable treatment for leukemia and lymphoma.

© Analytical reviews and oncology news by K. Mokanov: clinical pharmacist and professional medical translator