There are two types of hematopoietic stem cell transplantation:
- autotransplantation: autologous transplantation, using stem cells taken from the patient,
- allotransplantation: allogenic transplantation, using stem cells taken from a compatible brother or sister (known as a family or related transplant), or the stem cells of a voluntary and anonymous donor (an unrelated allogenic transplant).
In practice, a transplant that follows a course of chemotherapy (the conditioning) takes place like a blood transfusion, the stem cells themselves lodging in the bone cavities where they multiply and ensure the restoral of the hematological and immune system.
The first autologous transplantation of stem cells at the Jules Bordet Institute was carried out in 1981, followed by the first allogenic transplantation in 1984.
Our programme was approved in 2009 by the Joint Accreditation Committee of the ISCT and EBMT or JACIE, recognising it as a centre of excellence for autologous and related and unrelated allogenic stem cell transplantations.
The programme is growing, given the clear increase in transplant indications. We currently carry out about 35 autotransplants and 35 allotransplants a year. For the allotransplants we have a sterile unit with 6 laminar flow chambers.
Our programme is well supported by several specialists in medicine in addition to the hematologists specialising in transplantations, including infectiologists, intensivists and other specialists who possess the necessary skills to treat our patients.
Also, in order to provide our patients with the most innovative treatment, the unit is engaged in clinical research
• Academic, in cooperation with the Belgian Hematological Society (BHS), the EORTC, the LYSA, the IFM and the EBMT
• In cooperation with biotechnology firms for the handling of the graft in the framework of immunomodulation.
In most cases bone marrow transplants are proposed for patients with a hematologic malignancy with medullary consequences: acute leukaemia, myeloma, lymphomas, myelodysplasia and myeloproliferative syndromes.
An autotransplantation is generally the option for lymphomas and myelomas with allotransplantations being indicated for just a minority of patients for whom the autotransplantation did not provide sufficient control of the illness. Leukemias, myelodysplasias and myeloproliferative syndromes are preferably treated with an allotransplantation.
The age and general condition of the patient as well as prognostic factors are taken into account when making the graft decision that follows a reflection by all the service's hematologists on the benefits/risk to the patient inherent in the toxicity of the procedure and on alternative treatments.
An allogenic transplantation of hematopoietic stem cells is often the most effective way of strengthening immune responses to the disease through the reaction of the graft to the tumour, thereby obtaining the definitive elimination of the residual disease in a significant number of patients. The overall concept of the allogenous transplantation of hematopoietic stem cells has in fact evolved from the concept of organ transplant (replacement of a diseased organ with a new one) to that of creating an extraordinary immunotherapy platform in which the donor's immune system helps eradicate the residual tumoural cells. The past and present problem thus remains that of finding the best methods of immunomodulation to achieve a successful engraftment, a powerful anti-tumoural effect for the graft, and the absence or minimising of toxicity and of the deleterious effect of the graft against the host.
Given that only around 70% of patients with a high risk hematological disease and eligible for an allogenic transplant have a family or non-family donor who is fully HLA compatible, major efforts have been made to permit the use of alternative family donors who are haploidentical. The advantage of this approach is immediate access to a donor for nearly all patients. In the year 2000 already our transplant unit was a pioneer in Belgium in carrying out transplants of this kind and with recent progress in procedures the results obtained are now similar to those obtained in the case of HLA-identical non-family transplants when they are carried out among the same patient groups. Haploidentical transplantation has today become a value tool offering a reliable alternative in the search for the best donor for a given patient.
In cooperation with the pedriaticians from the HUDEF, the Institute has even drawn up a preclinical protocol for allotransplants destined for young adults with sickle cells that meets strict transplantation indication criteria.
The transplantation continuously welcomes doctors from Belgium and abroad who are training in hematology and who want to deepen their transplant knowledge. The unit's haematologists specialised in transplantation contribute to various master's programmes at the ULB in this field. They also contribute to inter-university teaching. Our team is also involved in the programme for a master's in cancer nursing organised by the Haute Ecole Ilya Prigogine.