Hematology is the field treating infants, children and adults suffering from blood forming and bone marrow diseases:
1. Leukemia and lymphoma, requiring anything from chemotherapy to bone-marrow transplants (BMT).
2. Anemia of all kinds and polycythemia.
Diagnosis and treatment are carried out within ambulatory outpatient clinics and laboratories, day hospitalization or full admittance for hemato-oncology patients.
Treatments include administration of combined cytotoxic medications according to internationally accepted protocols, injection of biological treatments such as interferon, erythropoyetin, interleukin - 2 and administration of agents that boost immunoglobulin levels.
Additionally, the leading hematologists conduct research designed to advance and improve the treatment of hematological and other diseases.
The Bone Marrow and Blood Cell Transplant units treat patients with various types of hematological diseases:
Acute and chronic Leukemia
Certain cases of breast cancer and sarcoma
BMT for non-malignant diseases, of which some are genetic and congenital and some metabolic related, is also performed.
Recently treatment of autoimmune diseases has been performed in cooperation with world renowned experts on autoimmune diseases and international experts on Multiple Sclerosis (MS).
Transplantation might be from a matched donor, whether from a family member or from an unrelated donor, and auto transplants in cases where the bone marrow itself is unaffected. In each case, cells of the bone marrow are harvested from the peripheral circulating blood in a process called Phoresis.
Multi-disciplinary consultation clinics assess and prepare both donors and recipients before transplantation, and conduct a thorough follow up program.
All units have adjacent laboratories preparing the cells for transplantation, storing frozen cells, and also test for acclimation of the transplant and for early detection of either rejection or recurrence of the disease. Reservoir vessels storing cells in liquid nitrogen are kept under electronic surveillance that is among the most advanced technology in the world.
Patients’ hematological disorders are evaluated quickly by an array of diagnostic procedures ranging from the basic to the most sophisticated including Cytogenetics, Fluorescence in Situ Hybridization (FISH), Flow Cytometry and DNA analysis by PCR techniques. These procedures allow an accurate diagnosis of the hematological malignancies and provide tools for monitoring response and minimal residual disease, mainstays of modern Cancer therapy. The physical proximity and daily interaction between the treating physicians and the laboratory staff assures timely and relevant evaluation.
The unique feature of these units is the specialized nursing staff that is highly trained and experienced to deal with complicated Hemato-Oncological patients. Our staffs deal successfully with the very difficult nursing and medical challenges, providing chemotherapy based on established protocols and treating the immune-compromised patients with various antibiotic regimens including antifungal and antiviral treatments.
Innovative Specialist's Clinics for other medical disciplines that are necessary to support patients post BMT operate in Israel. One of these clinics is the post BMT fertility clinic, operated by international experts in this pioneering field.
The Israeli departments are recognized by the European Bone Marrow Transplantation - EBMT and the International Bone Marrow Transplantation Registry - IBMTR, both international Autologous, Allogeneic, MUD, Haploidentical and Cord Blood Transplantation organizations. Israel is also a member of the National Marrow Donor Program - NMDP, an international organization for Allogeneic BMT from an unrelated tissue matched donor.
Israeli experts meet international criterion for BMT performance, and participate on a regular basis at international conferences on BMT and scientific publications and research on the subject.
In cases where no donor has been located or the patient's clinical status does not allow or does not require transplant from a donor the transplant is from stem cells taken from the patient's peripheral blood and cryo-preserved.
From an HLA tissue matched sibling or related family member, the stem cells are from peripheral blood, bone marrow or cord blood.
Allogeneic BMT from an unrelated donor
When no matched donor is located within the family, the stem cells come from an unrelated tissue matched donor. This kind of transplant can be performed when the donated graft is from the bone marrow, peripheral blood or cord blood.
Mismatched Allogeneic BMT and Haploidentical BMT
In some cases the tissue match might be only 50%, as in Haploidentical BMT. In cases of transplant from a family member with a 50% tissue match, the graft is taken from the peripheral blood after hematopoietic stem cell isolation and refinement using special columns. In cases where the donor is not a family member only a minor level of tissue mismatch is acceptable.
The stem cells used for the transplantation may be from a number of sources:
1. Stem Cell Mobilization
The donor's blood is tested and sub-cutaneous G-CSF injections and cell mobilization by Phoresis is performed. The number of cell mobilizations is determined by the number of stem cells required.
Cell mobilization is a simple process, takes only a few hours, and is similar to the procedure for blood or platelet donation.
2. Bone Marrow harvesting in the Operating Room (rarely):
This procedure requires that the donor is admitted, undergoes examination and testing, and an anesthesia consultation prior to the harvesting procedure.
3. Umbilical Cord Blood Harvesting
The cord blood gathered after birth is tested, and the blood is usually cryo-preserved in a Cord Blood Bank.
4. Graft Manipulation
In some cases removal of tumor cells or T cells from the graft is required. Almost total removal of the T calls is performed by isolating the hematopoietic stem cells (+CD34) and it is a prerequisite for successful transplantation from a mismatched donor. This procedure is performed today using special columns (separation device) and other separation techniques.
Bone marrow donation or peripheral blood or cord blood donation for transplantation are not risky procedures and they require only a few hours to complete. An Allogeneic Stem Cell donor, whether related or otherwise, tissue matched or mismatched, or partially matched, must perform the following blood tests: biochemistry, coagulations tests and virology. Successfully locating a donor is performed by searching the unrelated Data Bank, Registries of the Cord Blood Bank and locating the donor as fast as possible.
The Recipient – the patient in need of BMT
Prior to transplantation the patient undergoes extensive evaluation to determine his or her clinical and physical status, and to ascertain if the patient is in optimally good condition prior to transplantation.
This ambulatory evaluation and testing include blood tests, chest x-ray, electrocardiogram, imaging procedures such as CT scan, Gallium and Bone Scan, MRI, bone marrow aspiration and bone biopsy (if indicated), molecular evaluation, gynecological evaluation, dental treatment, cardiac function tests (MUGA and ECHO), pulmonary function testing, and referral for specialist consultation (if abnormal liver or kidney function test results are discovered) and possibly insertion of Hickman or Peakline Catheter.
Pre-transplantation Conditioning – chemotherapeutics administered before transplantation.
Conditioning involves chemotherapy with or without irradiation. Treatment with the most modern transplantation procedures, mini-transplantations (RIC, NST) or reduced intensity transplantation is based on temporary immune suppression and does not involve irradiation or high dose chemotherapy. Four factors govern the decision regarding the conditioning regiment: the patient's condition, the disease status, the type of transplantation and the level of tissue matching between the donor and patient.
A period of ambulatory treatment follows the transplantation and includes close patient monitoring, and testing and treatment at home and at the out patient transplantation Clinic. The treatment also includes immunotherapy (immunological) treatment with cytokines or lymphocyte cells.