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Melanie Cole (Host):  Stem cell transplants can help patients with certain blood cancers, including leukemia.  My guest today is Dr. Michael Keng.  He’s board certified in internal medicine and specializing in hematology including caring for patients with leukemia at UVA Health System.  Welcome to the show Dr. Keng.  People hear this word in the media—“stem cells” and “stem cell transplants”.  Please tell them what this means.

Dr. Michael Keng (Guest):  Absolutely.  Thank you for having me today.  I want to first just begin saying that stem cell transplants are something that involves a huge medical team in that we are all here in regards to our patients.  Stem cell transplant is basically deriving stem cells from a patient, whether that’s from the bone marrow or the blood itself or umbilical cord, and it’s the process of taking one of the stem cells from these sources and delivering them to a particular recipient that needs the stem cell transplant.

Melanie:  Who would be a recipient?  What type of patients would require stem cell transplantation?

Dr. Keng:  That’s a great question.  There are many types of indications for stem cell transplant.  I usually think of them as patients that have malignant versus non-malignant diseases.  What I mean by that are patients with malignant cancers such as leukemia, including acute myelo leukemia, acute lymphoblastic leukemia and also other special bone marrow disorders, such as myelodysplastic syndromes and also myeloproliferative  disorders.  If a patient has a relapse or a refractory disease in multiple myeloma and Hodgkin’s lymphoma or non-Hodgkin’s lymphoma, these patients can also proceed to stem cell transplant.  Non-malignant cases, meaning cases that are not considered cancers, can also require stem cell transplant such as thalassemia, sickle cell anemia, aplastic anemia and other immunodeficiency syndrome.

Melanie:  Dr. Keng, before I ask you about the people that are donating the stem cells, is there a pre-treatment that patients have to go through before they can have a stem cell transplant?

Dr. Keng:  Absolutely.  It honestly depends on what your baseline diagnosis is.  For example, if you are a patient that has been diagnosed with leukemia, a patient must be in remission before heading to a stem cell transplant.  Remission treatment usually involves chemotherapy or other targeted therapies to suppress or remove these cells altogether from your body.  If you have specific non-malignant cases like I discussed earlier, these may not require intensive therapies but a stem cell physician would be able to tell you specifically when would be the best timing for a stem cell transplant.

Melanie:  Where are you getting the stem cells?  That’s been such a source of controversy both in politics and the media but it’s really not the same thing is it, what you’re talking about?

Dr. Keng:  No.  These stem cells are not embryonic stem cells that has created such controversy in the media.  These stem cells are what we call “hematopoietic stem cells”.  Hematopoietic basically means derived from the bone marrow.  These stem cells only have the ability to grow into the common cells that we are concerned about such as white blood cells, red blood cells and platelets and other bone marrow cells.  We get these cells from the bone marrow itself or the proliferal blood or umbilical cord blood.

Melanie:  So, when you’re getting these stem cells who are you getting them from?  Are these willing donors?  Are people, then, step up if it’s someone in the family?  Do you have to be a match?  How does the donation work?

Dr. Keng:  All bone marrow donors are coming from volunteers.  They are 100% volunteers that do not receive any payment for stem cell transplant.  What we typically look for, depending on what type of transplant one condition needs; for example, if someone needs an autologous stem cell transplant, these are when stem cells are used from the patient themselves.  There’s something called “allogeneic” stem cells where stem cells are from a donor that’s not the patient.  An autologous stem cell transplant is probably the lease controversial because these are stem cells that are collected from the patient himself or herself and will be used and infused to the patient at some other time in the future when the disease is taken care of.  However, in allogeneic stem cell transplant is when stem cells are derived from a donor other than from the patient himself or herself.  These donors are all volunteer based, like I said, and what we prefer is a matched sibling donor. If a sibling is not available, we commonly look in the National Bone Marrow Registry to see if there is a non-related match available.  However, if a non-matched donor is not available, we can look at umbilical cord blood and also newer technology involves using what we call “half-matched” donors that could provide stem cells for the donor himself.

Melanie:  Dr. Keng, does it hurt to donate stem cells to someone that you love?

Dr. Keng:  No.  It does not hurt.  Actually, it is something that will probably give you a lot of satisfaction and just meaning that you’ve donated life literally to a patient or to someone that you love.  There are procedures that are done prior just to make sure that you are an adequate candidate to donate stem cells, meaning without infections or other disorders that would prevent you from donation.  The actual donation process, depending on whether the source is from bone marrow or peripheral blood, can be tailored according to what is needed.  There are various procedures that allow these stem cells to be received without any pain.

Melanie:  What happens once you give the stem cells to a patient?  How long does it take for them to start regenerating and helping this person to get better?  Is this a permanent situation or do they have to have this kind of transplant on a regular basis?

Dr. Keng:  When a patient needs to undergo a stem cell transplant, this is done in the hospital, in the in-patient setting. What I will be referring to is first autologous stem cell transplant--patients who need stem cells from himself or herself would undergo chemotherapy and/or radiation.  This would allow the current bone marrow to be completely removed and allow stem cells to be infused back in.  This process of bone marrow recovery would take approximately 10-14 days.  However, if you are receiving an allogeneic stem cell transplant, meaning stem cells from another donor, this process can be a little bit longer.  The preparatory regimen to remove the current bone marrow can be quite aggressive but the stem cells that are infused in should be able to begin recover in the time period of 14-20 days.  Everyone is a little bit different but this is why everything is individually based when it comes to stem cell transplantation.

Melanie:  UVA as received accreditation from FACT and from the National Marrow Donor Program.  Explain a little bit, Dr. Keng, what those recognitions mean.

Dr. Keng:  Absolutely.  FACT is an accreditation that allows us to be able to obtain and to be able to appropriately process and to be able to deliver stem cells back to a particular recipient.  This is given after many checks and balances that would allow us to do this successfully without any complications.  It’s not given to all institutions.  You have to show that you follow specific policies and protocols that are set forth by the FACT accreditation.  The NMDP, which is the National Bone Marrow Registry Program, allows us to be able to access donors who are willing to provide stem cells for our patients.  Once again, this is a particular accreditation that is not given to any program that wants to perform stem cell transplants.  You must show that you have an appropriate team, that you have good quality measures to be able to perform stem cell transplants appropriately before receiving this accreditation.

Melanie:  That’s fascinating, Dr. Keng.  I applaud all the great work that you’re doing.  How cool is that what you get to do?  In just the last minute here, why should patients come to UVA Cancer Center for treatment for their blood cancers?

Dr. Keng:  The University of Virginia is a growing program and it is amazing to see what is being done with acute leukemia and stem cell transplantation programs.  We have a multi-disciplinary team including physicians, nurses, pharmacists, physical occupational therapists, nutritionists and also social workers who all come together to care for the individual patient.  No one patient is the same for us and we love to be able to call each one of our patients family because they are with us through this process. Once you become a part of UVA as a patient, you are forever a patient with us and we love the privilege and the honor to be able to take care of all patients who chose UVA.

Melanie:  How beautifully put, Dr. Keng.  Thank you so much for being with us.  You’re listening to UVA Health Systems Radio.  For more information you can go to UVAHealth.com.  That’s UVAHealth.com.  This is Melanie Cole.  Thanks so much for listening.