Dato Dr Chang Kian Meng: “The earlier you receive stem cell transplantation, the higher the chance of cure and the lower the chance of recurrence”.

The human body is composed of tens of thousands of cells, of which stem cells are the most amazing. Stem cells are non-differentiated cells. They can develop into various “specialist” cells in the body and perform what have been called “acts of biological resurrection” to reproduce new cells and to repair damaged tissues and organs.

Dato Dr Chang Kian Meng, a consultant hematologist and transplant medicine at Sunway Medical Center, pointed out that stem cells are the ‘mother of cells’ to supply new cells. “Each organ of our body, such as the heart, liver, lungs, kidneys, etc., have their own unique types of stem cells. Stem cell transplantation is to transplant healthy stem cells into the patient’s body to repair or replace damaged cells”. It is encouraging that with the advancement of transplantation technology, the risk of transplantation has dropped from 30 to 40% in the past to about 10% to 15% today.

Hematopoietic stem cell transplantation is most commonly used for aplastic anemia, leukemia, thalassemia, bone marrow failure, multiple myeloma, lymphomas, sickle cell disease, severe combined immune deficiency syndrome and etc.

In summary, these stem cells can be obtained from bone marrow, peripheral blood stem cells and cord blood. “No matter where the stem cells are taken, they have their own advantages and disadvantages. It is impossible to say which is the best. At present, peripheral blood stem cell transplantation is the most commonly used. Approximately 70% of patients choose this therapy, and 20% use bone marrow transplantation, only 10% of patients use cord blood stem cell transplantation because they cannot find a suitable donor between their siblings.” Dato Dr Chang Kian Meng remarked.

Patients with blood cancer to undergo chemotherapy first to achieve high success rate in stem cell transplantation

Due to the continuous advancement of transplantation technology, such as mini-allogeneic hematopoietic stem cell transplantation, lowering the dose of chemotherapy and electrotherapy for transplantation, more patients can receive stem cell transplantation. “At present, stem cell transplantation has the highest success rate for aplastic anemia, thalassemia, and bone marrow failure.”

Dato Dr Chang also urged patients with blood cancer to undergo chemotherapy to control their condition before transplantation. The success rate will be higher. The survival rate of transplantation treatment varies with the types of diseases. For patients with bone marrow failure and thalassemia, the survival rate can reach 70% to 80%, and for patients with blood cancer, it can reach 50% to 60%. For patients with acute leukemia with an excessively high white blood cell index, stem cell transplantation is also required after several times of chemotherapy to control the condition. After chemotherapy, patients with chronic myelogenous leukemia also need stem cell transplantation if the condition recurs.

“For a small number of patients who relapse after transplantation, there are other treatment options. They can use a new cell therapy, that is, through immune cells-T cell therapy, to fight against blood cancer. Some patients with multiple myeloma, lymphoma, and chronic myelogenous leukemia can already be treated with drugs. Patients only need to undergo transplantation if the drugs and chemotherapy are ineffective.”

However, Dato Dr Chang also explained that certain diseases, such as adult leukemia, still need stem cell transplantation, because only 20% to 30% of patients can be controlled by drugs and chemotherapy, and about 60% to 70% of patients still need stem cell transplantation. Conversely, 70 to 80% of children’s leukemia can be cured by drugs and chemotherapy.

Dato Dr Chang reminded the public not to delay stem cell transplantation. “With the advancement of modern medicine, stem cell transplantation has been very successful and safe. If the doctor tells you that your illness has no signs of improvement and you must be cured by stem cell transplantation, don’t delay, and receive stem cell transplantation therapy as soon as possible before your condition worsens.”

Types of stem cell transplantation

Stem cell transplantation is mainly divided into two types, namely autologous stem cell transplantation (Autologous) and allogeneic stem cell transplantation (Allogeneic). Autologous transplants involve the use of a person’s own stem cells before beginning a damaging therapy to cells like chemotherapy or radiation. After the treatment is done, your own cells are returned to your body. You can opt for this method if you have a healthy bone marrow and it reduces the risk of complications such as GVHD.

Meanwhile for Allogenic transplant, the method involves the use of cells from a donor and they have a higher risk of certain complications, such as GVHD. You’ll also probably need to be put on medications to suppress your immune system so that your body doesn’t attack the new cells.  The success of an allogeneic transplant depends on how closely the donor cells match your own. Often, a compatible relative is the best choice, or a genetic match can be found from a public bone marrow bank or cord blood bank.

“Because many people cannot find an HLA match, the latest technology is that as long as half or more of the HLA matches, transplantation can be performed, but the risk is 10% higher.”

Dato Dr. Chang said that the patients undergoing allogenic transplantation are those with blood cancer, thalassemia or bone marrow failure, because the patient’s bone marrow or blood has disease. The biggest challenge is that rejection may occur after transplantation.

Frequently Asked Questions

  1. What are the issues that patients need to take note in undergoing stem cell transplantation?

    Prior to the transplant, the patient must undergo an HLA paired examination. Age and physical health are also considerations. Because radiotherapy and chemotherapy must be performed before transplantation, people over 60 years of age are not encouraged to do it, especially allogenic transplantation, because the older the age, the higher the risk.
  1. What is the process of transplantation?

    Before transplantation, medical staff will use 5 to 6 days to clean the patient’s bone marrow through injections, medications, and electrotherapy. Donors use “blood washing” or extract stem cells from bone marrow. Patients undergoing hematopoietic stem cell transplantation can be discharged from the hospital within 3 weeks; those undergoing bone marrow transplantation can take about 5 weeks.
  1. What should the patient take note after receiving the transplant?

    In the first 3 months after the completion of the transplantation, follow-up visits must be intensive. Generally speaking, normal daily routine can be resumed after 3 months; work or school routine can resume in 6-9 months. If there is no rejection in the first 3 months, the problem is not big; within 3 years, if there is no relapse, it is considered a success. Within one year after treatment, patients should avoid eating raw or semi-cooked foods.
  1. What are the side effects of stem cell transplantation?

    Rejection-related side effects may occur in the short term; but in the long term, attention must be paid to the effects of organ damage caused by chemotherapy and electrotherapy.
  1. Haemato-Oncology unit at Sunway Cancer Centre

    Cancer Care
    – Medication therapies
    – Targeted therapy
    – Chemotherapy
    – Radiotherapy
    – Bone marrow transplant
    – Immunotherapy
    – Gene or cell therapy
  1. Why choose Sunway Medical Centre?

    Our specialised and integrated care in BMT transplant journey include:
    – Stem cell collection (Apheresis)
    – Conditioning
    – Stell cell infusion (Transplant)
    – Post-transplant care

    A complete and dedicated transplant team:
    – Haematologist
    – Medical Oncologist
    – Interventional Radiologist
    – Specially-trained Transplant Coordinators