For patients with immune disorders and blood cancers, such as leukemia, multiple myeloma and lymphoma, stem cell or bone marrow transplants can offer potential cures.
Listen in as Dr. Leonid Volodin, a UVA expert in these transplants, how a new designation earned by the UVA Cancer Center’s Bone Marrow and Stem Cell Transplant Program will help patients access these vital treatments.
Selected Podcast
Expanding Access to Stem Cell and Bone Marrow Transplants
Featured Speaker:
Dr. Leonid Volodin
Dr. Leonid Volodin is board certified in hematology and medical oncology and specializes in working with patients who need bone marrow or stem cell transplants. Transcription:
Melanie Cole (Host): For patients with immune disorders and blood cancer such as leukemia and multiple myeloma and lymphoma, stem cell or bone marrow transplants can offer potential cures. My guest today is Dr. Leonid Volodin. He is board certified in hematology and medical oncology at UVA Health Systems. Welcome to the show, Dr. Volodin. Speak first about when would somebody need a bone marrow or stem cell transplant? When would this be considered for a patient?
Dr. Leonid Volodin (Guest): Thank you, Melanie. Thank you for inviting me to the show. Bone marrow transplant can be lifesaving for patients with hematological cancers, as you mentioned, conditions such as leukemia and lymphoma. For example, in case of leukemia, many of the non-transplant treatments can achieve cures but the cure rate is still relatively low for some of the high-risk leukemias. We’re talking only 20 to 30 percent of people being cured with non-transplant treatment. Transplant offers a more effective treatment for those types of patients, usually achieving a cure rate of 50 to 60 percent. This is one example for conditions such as refractory lymphomas or multiple myeloma. Transplant can also achieve cures or prolong remission rate. It is important to distinguish two types of stem cell or bone marrow transplants. One is autologous, when cells are taken from the patient him or herself, then after high-dose chemotherapy, re-infused back into the patient to recover their blood counts faster. The other one is allogeneic when a donor is needed. Donor cells are given to the patient after, once again, high-dose chemotherapy. In the case of allogeneic transplant, apart from getting the benefit of high-dose chemotherapy, the patient also benefits from the donor cells which often fight the disease directly in what’s called the graft versus leukemia or versus lymphoma effect.
Melanie: Let’s talk about the allogeneic. How are donors found? Is there a database like there is for other kinds of organ donation? Or does it have to be somebody you know? Speak about donation a little bit.
Dr. Volodin: Sure. As opposed to solid organ transplant, when one sometimes look at blood group, for example, and donor has to match in the blood. With allogeneic transplants, donor has to achieve an HLA match. HLA is a group of genes that’s located on chromosome 6 that are responsible for how our immune system interacts with the rest of our body, how it sees other molecules and distinguishes self from non-self, for example, eliminating viruses from our body. So if we transplant from a donor that’s not HLA-matched, the transplant is very likely to fail. The first source where we go to, to find a donor are siblings of the patients because we inherit half of our genes from one parent and half from the other parent. There’s a one-in-four chance that any one of our siblings may be a donor and be HLA-matched. However, if there are no siblings, or siblings are not in adequate state of health to donate, then we would go to an unrelated donor. There is this, as you mentioned, the NMDP or data match program that attracts volunteers from U.S., North America, and also around the world and currently has more than 15 million people who volunteered to donate for unrelated people or patients who need this donation. If there are no siblings, we go to the database and compare the patient’s HLA type to those of the donors available in the database and hopefully find a donor that way.
Melanie: UVA was recently designated as a National Marrow Donor Program and be the Match Transplant Center. Speak about how that really benefits the patients that come to UVA for bone marrow or stem cell transplants.
Dr. Volodin: Obviously, if before we had access to our related donors, we could only find donors among the siblings and so we had limited number of potential donors. Especially in small families where there may be only one sibling, the chances, as I mentioned, are only 25 percent. In the average American family, you would probably have a chance of 30 percent of having one of the siblings being a match. This significantly extends the number of donors that we have access to. Potentially if a patient previously could not have transplant because of lack of a donor, now we are able to find a donor and proceed to transplant and avoid any delays. Previously, patient might have had to go to another center that’s farther away. Now, he or she can come closer to where they live and have a transplant offered to them. Also, being part of NMDP is an attestation to our ability to provide comprehensive care. We had to match a certain requirement, show that we are able to provide comprehensive care for our patients who have 24-hour access to care post-transplant, able to rapidly access our system, be treated for complications, and also that our program follows certain standard operating procedures that enable us to provide the treatment in a reliable way and matching a certain quality. It’s all attestations of the level of quality of our programs. Both of those ways are beneficial to our patients.
Melanie: Dr. Volodin, why should patients who need a bone marrow or stem cell transplant come to UVA for their care?
Dr. Volodin: As I mentioned, those who do need transplant often receive their hematological care at UVA already by regionally and nationally recognized hematologists, and so us getting the transplant part to the options that they have at UVA allows for them to stay at UVA and continue their care. We closely communicate to non-transplant hematologists, and so this facilitates us providing the care in an efficient way and this allows us to minimize delays in providing the care. As I mentioned, being part of NMDP attests to the quality of care and the standards that our program has met so far. I think as perhaps somewhat smaller program compared to some of the big programs, we are able to provide more personable care where our patients get well-[acclimated] with various members of our team who work well together in close communication. The transplant is a procedure that’s performed by a team rather than an individual and so we have many dedicated doctors, nurses, transplant coordinators, cell processing, laboratory team, apheresis team and many other professionals, more than 20 people on our team who provide care to our patients.
Melanie: In just the last minute, people get a little bit afraid of donating bone marrow. Does it hurt? How is it for the donor itself? We only have about a minute left.
Dr. Volodin: Sure. As opposed to perhaps previously or older days when bone marrow donation was done through actually doing a surgical procedure, 95 percent of donations are done by extracting cells from peripheral blood. A person gets connected to an apheresis machine which is like a dialysis machine that centrifuges the blood, separating it into layers of cells, and the layer that’s rich in stem cells gets extracted while the rest of the blood gets re-circulated. It’s a relatively painless procedure and people from the ages of 18 to 45 are very much encouraged to join NMDP program. There’s probably one-in-500 chance of one actually being a donor during their lifetime, but it’s a very worthy cause especially for people of non-white ethnic groups where there is very much a need for more donors.
Melanie: Thank you so much. You’re listening to UVA Health Systems Radio. For more information on the UVA Cancer Center, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): For patients with immune disorders and blood cancer such as leukemia and multiple myeloma and lymphoma, stem cell or bone marrow transplants can offer potential cures. My guest today is Dr. Leonid Volodin. He is board certified in hematology and medical oncology at UVA Health Systems. Welcome to the show, Dr. Volodin. Speak first about when would somebody need a bone marrow or stem cell transplant? When would this be considered for a patient?
Dr. Leonid Volodin (Guest): Thank you, Melanie. Thank you for inviting me to the show. Bone marrow transplant can be lifesaving for patients with hematological cancers, as you mentioned, conditions such as leukemia and lymphoma. For example, in case of leukemia, many of the non-transplant treatments can achieve cures but the cure rate is still relatively low for some of the high-risk leukemias. We’re talking only 20 to 30 percent of people being cured with non-transplant treatment. Transplant offers a more effective treatment for those types of patients, usually achieving a cure rate of 50 to 60 percent. This is one example for conditions such as refractory lymphomas or multiple myeloma. Transplant can also achieve cures or prolong remission rate. It is important to distinguish two types of stem cell or bone marrow transplants. One is autologous, when cells are taken from the patient him or herself, then after high-dose chemotherapy, re-infused back into the patient to recover their blood counts faster. The other one is allogeneic when a donor is needed. Donor cells are given to the patient after, once again, high-dose chemotherapy. In the case of allogeneic transplant, apart from getting the benefit of high-dose chemotherapy, the patient also benefits from the donor cells which often fight the disease directly in what’s called the graft versus leukemia or versus lymphoma effect.
Melanie: Let’s talk about the allogeneic. How are donors found? Is there a database like there is for other kinds of organ donation? Or does it have to be somebody you know? Speak about donation a little bit.
Dr. Volodin: Sure. As opposed to solid organ transplant, when one sometimes look at blood group, for example, and donor has to match in the blood. With allogeneic transplants, donor has to achieve an HLA match. HLA is a group of genes that’s located on chromosome 6 that are responsible for how our immune system interacts with the rest of our body, how it sees other molecules and distinguishes self from non-self, for example, eliminating viruses from our body. So if we transplant from a donor that’s not HLA-matched, the transplant is very likely to fail. The first source where we go to, to find a donor are siblings of the patients because we inherit half of our genes from one parent and half from the other parent. There’s a one-in-four chance that any one of our siblings may be a donor and be HLA-matched. However, if there are no siblings, or siblings are not in adequate state of health to donate, then we would go to an unrelated donor. There is this, as you mentioned, the NMDP or data match program that attracts volunteers from U.S., North America, and also around the world and currently has more than 15 million people who volunteered to donate for unrelated people or patients who need this donation. If there are no siblings, we go to the database and compare the patient’s HLA type to those of the donors available in the database and hopefully find a donor that way.
Melanie: UVA was recently designated as a National Marrow Donor Program and be the Match Transplant Center. Speak about how that really benefits the patients that come to UVA for bone marrow or stem cell transplants.
Dr. Volodin: Obviously, if before we had access to our related donors, we could only find donors among the siblings and so we had limited number of potential donors. Especially in small families where there may be only one sibling, the chances, as I mentioned, are only 25 percent. In the average American family, you would probably have a chance of 30 percent of having one of the siblings being a match. This significantly extends the number of donors that we have access to. Potentially if a patient previously could not have transplant because of lack of a donor, now we are able to find a donor and proceed to transplant and avoid any delays. Previously, patient might have had to go to another center that’s farther away. Now, he or she can come closer to where they live and have a transplant offered to them. Also, being part of NMDP is an attestation to our ability to provide comprehensive care. We had to match a certain requirement, show that we are able to provide comprehensive care for our patients who have 24-hour access to care post-transplant, able to rapidly access our system, be treated for complications, and also that our program follows certain standard operating procedures that enable us to provide the treatment in a reliable way and matching a certain quality. It’s all attestations of the level of quality of our programs. Both of those ways are beneficial to our patients.
Melanie: Dr. Volodin, why should patients who need a bone marrow or stem cell transplant come to UVA for their care?
Dr. Volodin: As I mentioned, those who do need transplant often receive their hematological care at UVA already by regionally and nationally recognized hematologists, and so us getting the transplant part to the options that they have at UVA allows for them to stay at UVA and continue their care. We closely communicate to non-transplant hematologists, and so this facilitates us providing the care in an efficient way and this allows us to minimize delays in providing the care. As I mentioned, being part of NMDP attests to the quality of care and the standards that our program has met so far. I think as perhaps somewhat smaller program compared to some of the big programs, we are able to provide more personable care where our patients get well-[acclimated] with various members of our team who work well together in close communication. The transplant is a procedure that’s performed by a team rather than an individual and so we have many dedicated doctors, nurses, transplant coordinators, cell processing, laboratory team, apheresis team and many other professionals, more than 20 people on our team who provide care to our patients.
Melanie: In just the last minute, people get a little bit afraid of donating bone marrow. Does it hurt? How is it for the donor itself? We only have about a minute left.
Dr. Volodin: Sure. As opposed to perhaps previously or older days when bone marrow donation was done through actually doing a surgical procedure, 95 percent of donations are done by extracting cells from peripheral blood. A person gets connected to an apheresis machine which is like a dialysis machine that centrifuges the blood, separating it into layers of cells, and the layer that’s rich in stem cells gets extracted while the rest of the blood gets re-circulated. It’s a relatively painless procedure and people from the ages of 18 to 45 are very much encouraged to join NMDP program. There’s probably one-in-500 chance of one actually being a donor during their lifetime, but it’s a very worthy cause especially for people of non-white ethnic groups where there is very much a need for more donors.
Melanie: Thank you so much. You’re listening to UVA Health Systems Radio. For more information on the UVA Cancer Center, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.