Stem cells, which are the origin of all structures in the human body and have the ability to self-renew, are used in the treatment of many diseases. Prof. Dr. Barış Malbora provided information on the topic for individuals who want to receive stem cell treatment. In doing so, Malbora clarified the subject by explaining all the methods under the title of "Stem Cells."
THE METHOD OF REJUVENATION: PRP
PRP (Platelet-Rich Plasma) therapy, a field where rejuvenation and cell renewal are utilized, is based on a method where blood is taken from a patient, separated by a special process to obtain a plasma concentrate rich in platelets, and then injected into the targeted treatment area. Platelets in our blood have functions such as healing wounds, regenerating tissue, increasing collagen synthesis, and stimulating an increase in vascularization in the related area, as well as promoting regeneration in soft and bone tissue. Platelets perform these functions thanks to the various growth factors they contain, which enhance wound healing and accelerate tissue regeneration.
PRP therapy is not a stem cell therapy. With the PRP method, the number of platelets is increased. After the application, the fibrin networks that form on the skin indirectly work with stem cells by collecting the stem cells in the area into their structure. This is how they try to find a solution for the skin problems mentioned above. I want to emphasize this again: PRP is not a stem cell transplant method.
THE METHOD USED IN INFERTILITY TREATMENT (IVF)
Stem cells are also used in the practice of obstetrics and gynecology. This method has found application in the treatment of gynecological oncology (cancers of the female reproductive organs), perinatology, and infertility. Stem cells can be used in the treatment of gynecological tumors, prenatal transplantation, and gene therapy applied within the uterus. Fetal stem cells (from the fetus in the mother's womb) can help with tissue repair through microchimerism in the mother. Stem cells can also be used in infertility and IVF (in vitro fertilization) research and treatment.
THE BONE MARROW TRANSPLANTATION METHOD:
Another area where stem cell therapy is used is the type of treatment most commonly known as bone marrow transplantation. The basic principle of bone marrow transplantation is to take stem cells that produce blood cells from healthy individuals (donors) and give them to the patient. The goal is to completely eliminate the patient's existing disease and restore their health. It is used as a definitive treatment method for leukemias, as well as for congenital immune system diseases, metabolic diseases, blood disorders such as Mediterranean anemia and sickle cell anemia, and some genetic diseases.
Prof. Dr. Barış Malbora provided explanations about this important and effective method, especially for the treatment of blood or bone marrow cancer, commonly known as leukemia. He answered frequently asked questions.
HOW ACCURATE IS IT TO USE THE TERM BONE MARROW TRANSPLANTATION?
Stem cells are the fundamental cells that provide the formation, proliferation, and repair of our tissues in the body. Bone marrow is not the only source of these cells. We also have these stem cells in our peripheral blood in our veins and in our umbilical cord blood at birth. If we were to list them from least to most in terms of the amount of stem cells they contain, it would be the blood circulating in our veins, bone marrow, and cord blood. Although cord blood is abundant in a newborn baby, a large number of stem cells cannot be obtained from it because the total volume is less than other sources.
ARE BONE MARROW TRANSPLANTATION AND STEM CELL TRANSPLANTATION THE SAME THING?
The term bone marrow transplantation, which is mainly used for blood (marrow) cancer, commonly known as leukemia, is not a completely accurate term. Stem cell transplantation is a more accurate and comprehensive term. The reason why we, as physicians, also incorrectly use the term bone marrow transplantation is that bone marrow is the most common source of stem cells obtained for treatment purposes. As I said before, in addition to bone marrow, peripheral blood and cord blood are also our stem cell sources. In short, the umbrella term is stem cell transplantation. It is used synonymously with bone marrow transplantation because bone marrow is the most commonly used of the sources.
Today, stem cell therapy is used in different fields of medicine. It is used by orthopedic surgeons for cartilage and bone formation. These cells are obtained by culturing them in a laboratory environment. However, the main field of use is for 'blood (hematopoietic) stem cell' transplants, which we, as adult and pediatric hematology (blood diseases) physicians, use for many blood diseases, congenital diseases, and organ cancers, especially leukemias.
HOW ACCURATE IS IT TO USE THE TERM BONE MARROW TRANSPLANTATION?
Stem cells are the fundamental cells that provide the formation, proliferation, and repair of our tissues in the body. Bone marrow is not the only source of these cells. We also have these stem cells in our peripheral blood in our veins and in our umbilical cord blood at birth. If we were to list them from least to most in terms of the amount of stem cells they contain, it would be the blood circulating in our veins, bone marrow, and cord blood. Although cord blood is abundant in a newborn baby, a large number of stem cells cannot be obtained from it because the total volume is less than other sources.
ARE BONE MARROW TRANSPLANTATION AND STEM CELL TRANSPLANTATION THE SAME THING?
The term bone marrow transplantation, which is mainly used for blood (marrow) cancer, commonly known as leukemia, is not a completely accurate term. Stem cell transplantation is a more accurate and comprehensive term. The reason why we, as physicians, also incorrectly use the term bone marrow transplantation is that bone marrow is the most common source of stem cells obtained for treatment purposes. As I said before, in addition to bone marrow, peripheral blood and cord blood are also our stem cell sources. In short, the umbrella term is stem cell transplantation. It is used synonymously with bone marrow transplantation because bone marrow is the most commonly used of the sources.
IS STEM CELL TRANSPLANTATION USED ONLY FOR LEUKEMIA TREATMENT?
The disease for which we most frequently use stem cell transplantation is leukemia, or in other words, blood cancer/bone marrow cancer. However, leukemia is not the only disease group we use it for. Stem cell transplantation is also applied for Mediterranean anemia (thalassemia), a blood disease common in our country, for congenital or acquired bone marrow failure where the bone marrow does not work (aplastic anemias), for organ cancers, and for congenital immune deficiency and metabolic diseases.
IS A STEM CELL TRANSPLANT PERFORMED ON EVERY LEUKEMIA PATIENT?
At the point where today's medicine is, we do not perform bone marrow transplants on every patient. This rate constitutes only 15% of childhood leukemias.
So, what patients make up this 15% group?
We perform stem cell transplants on 'high-risk' patients who do not respond to chemical drugs, which we call chemotherapy, or who we predict will relapse based on our experience. This 15% I'm talking about is, of course, only valid for our leukemia patients. For all the patients I mentioned with other blood, immune system, and metabolic diseases, the only solution for now is stem cell transplantation. In some disease groups, genetic therapy is also on the agenda as a new hope. However, it has not yet passed the experimental stage for many diseases.
IS A STEM CELL TRANSPLANT A LIFELONG CURE, OR CAN THE DISEASE RELAPSE?
While a stem cell transplant is the final and definitive solution for the diseases I have just listed, unfortunately, the underlying disease can sometimes relapse. The reason for this relapse may vary depending on the underlying disease, the preparation method applied before the transplant, and the patient's clinical condition. For example, in childhood leukemias, there is a 5-15% chance of relapse, while this rate is higher in a congenital bone metabolism disorder called osteopetrosis. The reason for this lies in the disease itself. In this disease, since the patient's bone tissue fills the marrow, it is more difficult for the externally given stem cells to settle in this area. Does this mean we have no chance of treating these patients? Of course, we do have a chance for treatment. We perform a second stem cell transplant in such patients who have relapsed.
IS THE STEM CELL TRANSPLANT PROCESS A VERY PAINFUL TREATMENT?
The answer to this question changes depending on our perspective and where we are. If we are on the donor side, our job is easy. If we have to answer this question from the patient's side, there are, of course, difficult moments. Here, let's first look more closely at the process from the perspective of the stem cell donor. After the donor and patient's tissue types are matched, the donor is asked 'if they still want to be a donor.' If the answer is 'yes,' the donor undergoes a health check and blood tests for infectious diseases. After the donor successfully passes this process, the time when the patient needs stem cells and the stem cell collection location are communicated by the patient's doctor to the donor's doctor. The donor's doctor then communicates these requests to the donor. The final decision here belongs entirely to the donor. This means that the donor shapes both the stem cell collection time and the method of stem cell collection according to their own wishes. In other words, the donor decides whether to collect the stem cells from the bone marrow or from the vein.
If stem cells are to be collected from the bone marrow, the process proceeds a little differently. There are no booster shots like the stem cell method obtained from the vein before this procedure. The evening before the stem cell collection, the donor is admitted to the hospital. After a twelve-hour fast, the stem cells are collected from behind the hip bone on both sides with special needles under general anesthesia, completely painlessly. This procedure also takes about 40-60 minutes. The biggest complaint after the procedure is pain at the site where the needle was inserted. If the donor is smaller in body weight than the patient, it is necessary to collect a large volume of product to obtain a large number of stem cells. In this case, it may be necessary to give the donor red blood (erythrocytes) after the product collection. We most often encounter this situation with heroic siblings who are giving stem cells to their older brother or sister. If the donor is large enough, we take their own blood 1-2 weeks before the procedure and give it back to them if needed. This way, we prevent them from receiving blood products from someone else. In cases where we collect stem cells from the bone marrow, the donor is sent home one day after the procedure.
Another source of stem cells is cord blood. We obtain this by stripping the umbilical cord as soon as the baby is born. Although it contains highly concentrated stem cells, its small volume is its biggest handicap. For this reason, it is insufficient for patients with a high body weight. Another handicap is that the transplant takes hold later than with other stem cell sources.
BECOMING A STEM CELL DONOR
Becoming a donor candidate is a good start, but of course, it is not enough. After this, you should wait excitedly to be a source of hope for a patient anywhere in our country or the world, and after receiving the news that your tissue is a match, you should run to the donor center. I said "our country or the world" because TÜRKÖK, our country's stem cell bank, does not only serve our citizens. Since 2017, it has also been working with banks all over the world. Therefore, when you become a stem cell donor, you become a stem cell donor in the global pool. We are fulfilling a universal duty.
Sometimes we can find more than one donor candidate for a patient from banks in our country or around the world. But sometimes, only one donor candidate is found for a patient in this vast world. If you are that person, know that you are the only branch for the patient to hold on to life. Please let's not forget that by backing out after becoming a donor candidate and matching with a patient, we have taken away a person's last hope and perhaps their chance at life.
Source: Sabah