Stem Cell

Frequently Asked Questions

Stem Cell Therapy

Glossary: Stem Cell Transplants

allogeneic (“allo”): Stem cell transplantation using cells donated by another person.

anemia: A condition caused by a lack of red blood cells, the cells that transport oxygen to the body’s tissues.

antibodies: Proteins made by your body that fight off foreign substances.

antigen: A foreign substance, such as a bacteria, virus, or tissue, that does not come from your body.

apheresis: A process in which whole blood is drawn from a donor, thestem cells are then harvested, and the other blood products are returned to the donor.

autologous: Stem cell transplantation using your own stem cells.

bone marrow: The spongy part of some bones, where blood cellsdevelop from immature marrow cells called stem cells.

bone marrow transplant (BMT): A transplant containing all three types of blood cells that develop in the bone marrow: red cells, white cells, and platelets. (Stem cell transplants only use the immature stem cells from the circulating blood.)

cord blood transplant: Stem cell transplant using cells collected from the umbilical cord and placenta of healthy newborns.

conditioning (cytotoxic or myeloablative) treatment: High-dosechemotherapy and/or radiation given before a stem cell transplant.

embryonic stem cells: Immature cells from umbilical cord blood that can develop into many types of cells, including blood cells.

granulocyte colony-stimulating factor drugs: Growth factor medicines given to draw stem cells from the bone marrow into the bloodstream.

graft (autograft or allograft): The new blood-producing cells that develop after a successful stem cell transplant.

graft-versus-host disease: A condition in which donor cells think the recipient’s cells are foreign and attack them.

graft-versus-tumor effect (GVT): The good response that happens when the donor cells attack any of the recipient’s cancer cells that may remain after chemotherapy.

growth factor: Medicines that boost the numbers of infection-fighting white blood cells.

harvesting: The process of collecting stem cells.

hematopoietic stem cells: Immature blood cells or blood-forming stem cells.

hematopoiesis: The process by which the body makes red blood cells.

human leukocyte antigens (HLA): Proteins found on the surface of white blood cells and tissues. A tissue-typing test shows how many HLA matches the recipient has in common with a donor.

immune system: A network of cells, tissues, and organs that protects your body from disease and infection.

indwelling catheter (central line): A tube surgically placed in your chest near your neck through which to give chemotherapy and receive your stem cell infusion. It may also be used to draw blood. This type of catheter is also known as a “port.”

infusion: Delivery of liquid medicine or treatment through a vein.

matched unrelated donor (MUD): A donor who is not a blood relative, but who has a complete HLA match to the patient. These donors are often found through bone marrow registries.

monoclonal antibodies: Molecules made in a laboratory, engineered to attach to your cancer cells so they can be seen as foreign and attacked by your immune system.

mucositis: Mouth sores that result when chemotherapy destroys the mucosal cells that line the mouth and intestinal tract.

peripheral blood stem cells (PBSC): The small number of stem cells that make their way from the bone marrow to the circulating blood.

platelets: Cells that prevent or stop bleeding.

purging: The process of separating cancer cells from bone marrow or stem cells.

red blood cells (erythrocytes): Cells that carry oxygen.

reduced intensity (non-myeloablative or “mini-“) transplant: A conditioning process in which lower doses of chemotherapy and/or radiation — or none at all — are given prior to stem cell transplant; often used with slow-growing cancers or for older or sicker people.

remission: A period of time when the cancer is not active and you have no symptoms.

stem cells: Immature cells that develop into white and red blood cells and platelets. Most live in the bone marrow, but some (peripheral stem cells) are in the bloodstream.

syngeneic: Stem cell transplant using cells from an identical twin.

tandem (double autologous) transplants: A process in which you have two stem cell transplants with your own cells, done about three to six months apart, to increase chances of success.

tissue typing (HLA typing): A test to see how many antigens match on your cells and your donor’s cells. The closer the match, the lower the chance that your immune system will fight the new cells.

white blood cells (leukocytes): Cells that are part of the body’s immune system, which fights disease and infection.

 

WebMD Medical Reference

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Reviewed by David T. Derrer, MD on May 29, 2014

© 2014 WebMD, LLC. All rights reserved.

Are there different types of MSC’s?

Yes. There are two main types for orthopedic applications of MSC’s, bone marrow and adipose (fat derived).  Bone marrow MSC’s are taken via a needle through bone marrow aspirate. The bone marrow aspiration procedure sounds like a big deal, but we are constantly told by patients that the procedure is very well tolerated.

The second type of MSC is derived from adipose. This can be obtained via liposuction. Literature indicates that this fat derived MSC’s or adipose Stem Cell derived MSC’s consistently and dramatically underperform versus bone marrow derived cells. In studies of cartilage repair, bone repair and soft tissue repair, bone marrow derived MSC’s are much adapt at these tasks.

Will my body reject the STEM CELLS?

No, since the cells are obtained from your body (autologous) and processed quickly at point-of-care, they will not be rejected.

Are there any side effects to the procedure?

Like any injection (bone marrow biopsy and ultrasound injection of the Stem Cells), side effects can occur like discomfort or pain at the injection site, infection, etc.

Can the re-implanted adult STEM CELLS cause cancer?

No. Several studies utilizing the Stem Cell therapy you will receive did not show any serious complications, and there was no evidence to show any patient developing a STEM CELL related cancer.

What is Regenerative Medicine?

Regenerative medicine is an emerging clinical approach to adopt the power of STEM CELLS to improve the repair and regeneration of damaged tissue.

Do the STEM CELLS stay localized to the injection site? Is there any risk of them traveling throughout the body?

The Stem Cell therapy you will receive involves making an injection into the site of pathology, and in this situation, the majority of Stem Cells will remain at the site of injection.

How long will the STEM CELLS last?

It will depend on your injury, the area that is treated and your response to the therapy.

How long will it take to see results?

Depending on the condition being treated, your perception of improvement might vary from 2 weeks to 4 weeks.

What are adult STEM CELLS?

Adult STEM CELLS are unique in the body, since they can expand in number (self-renewal) without becoming a tissue cell, but they also can differentiate into various cells found in mature tissue, like skin cells. They are vital to maintaining tissues in the body such as internal organs, skin and blood.

Will I need a second procedure?

Some of the patients require a second and even third procedure, but this is dependent on their injury. Our usual protocol involves 1-2 injection cycles.

Where do adult STEM CELLS come from in the body?

In adults, STEM CELLS are present within various tissues and organ systems, but the most accessible locations of MESENCHYMAL STEM CELLS are the bone marrow and adipose (fat) tissue. Other sources include the liver, epidermis, retina, skeletal muscle, intestine, brain, placenta, umbilical cord and dental pulp.

When can I return to normal activity?

This depends on the type of procedure. However, all our procedures are designed to promote as much early activity as possible.

In joint procedures with minimal cartilage loss, low impact activities would be encouraged immediately after the procedure. Full impact activities would be expected at 4-6 weeks. In partial tendon/ligament/muscle tears, – Low impact activities would be encouraged immediately after the procedure and full impact activities would be expected at 4- 6 weeks.

What is the difference between adult Stem Cells and embryonic Stem Cells?

  1. Adult STEM CELLS are found in mature adult tissues, including bone marrow and fat, while embryonic stem cells (ESCs) are not found in the adult human body.
  2. Embryonic Stem Cells (ESCs) are obtained from donated embryos provided during in vitro fertilization procedures, which raises many ethical concerns. Because ESCs are not obtained from your body, there is a possibility of immune rejection if the ESCs were to be implanted. Adult STEM CELLS do not raise ethical issues nor pose any risks for immune rejection..

Are Stem Cell procedures the same as PLATELET RICH PLASMA (PRP)?

No. PRP therapies use healing properties that are targeted at recruiting adult Stem Cells to an injury site that are responsible for healing. So, in a Stem Cell procedure the patient receives not only the factors found in PRP, but also the Stem Cells that are responsible for tissue repair.

How much will it cost?

The cost of Stem Cell portion of therapy isn’t covered by insurance companies, so ask your doctor for details on cost and payment options.

What are the different types of adult Stem Cells?

There are many types of adult STEM CELLS found in the body, which have variable regeneration potentials. The multipotent, mesenchymal STEM CELL, (MSC) is one of the adult STEM CELLS that support repair of damaged tissue. The hematopoietic STEM CELL (HSC) is the STEM CELL that supports the creation of all of the types of cells found in your blood: red blood cells, white blood cells and platelets.

What is the difference between autologous and allogeneic adult STEM CELLS?

Autologous cells are cells taken from a patient and returned to that patient, typically at point-of-care.  Allogeneic cells are taken from a donor and often are manipulated before they are given to a patient.

What type of STEM CELLS are used at The STEM CELL Institute of Texas?

We only use the patient’s own cells, so they are autologous adult STEM CELLS.

Is STEM CELL therapy safe?

Yes, and ask your doctor what clinical studies have been done to show that STEM CELLS are safe and effective.

Is the procedure FDA approved?

The FDA allows physicians to remove bone marrow from your hip, process it briefly and then use the STEM CELL-containing preparation for treatment. Read about STEM CELL regulation.

Are there ethical issues associated with harvesting Stem Cells?

No, adult STEM CELLS do not raise ethical questions as they are harvested from the patient’s body.

Are there cancer-causing risks associated with adult Stem Cell treatments?

No. While embryonic STEM CELLS have been show to form teratomas (germ cell tumors), there is no data that suggests adult STEM CELLS have the same potential to promote the development of tumors. In fact, a recently published report showed that there was no risk for tumor formation at the site of autologous bone marrow concentrate injection. This is a study of 1,873 patients who were treated for orthopedic diseases with an average follow up of 12.5 years, which includes one group of patients who have no evidence of tumor formation after 22 years.

How are adult STEM CELLS used in therapeutic procedures?

Adult STEM CELLS are used to treat patients with damaged tissues due to the aging process or trauma. During a procedure, STEM CELLS are isolated from the patient, concentrated and delivered back to the site of injury to assist in the healing process.

What basic science data exists that shows that concentrated Stem Cells from bone marrow can help heal orthopedic injuries?

Basic science data has been obtained that show the biological activities of adult Stem Cells. Clinical studies have been reported starting in the 2000’s showing a benefit to being treated with your Stem Cells for both soft tissue and bony pathologies.

How do STEM CELLS know what type of tissue to develop into?

The differentiation of Stem Cells is a very complex process, and depends on the ability of Stem Cells including to respond to adult tissue cell-derived and micro-environmental signals. Based on these cues, the Stem Cells will respond appropriately, including the potential to develop into healthy tissue needed to repair damaged tissue. For example, mulitpotent Stem Cells delivered to damaged bone will promote the development of bone cells to aid in tissue repair.

How does the physician obtain adult STEM CELLS for use in cell treatment?

Dr. Hirsch/Dr. Hall obtain the cell material by aspirating bone marrow from your hip bone during your therapeutic procedure.

Are the harvested adult Stem Cells expanded in a laboratory setting prior to delivery back to the patient?

No, Dr. Hirsch and Dr. Hall do not use in vitro expansion. The bone marrow aspirate is obtained, placed in a sterile device, centrifuged and the adult Stem Cells are recovered, all of which happens close to the treatment room.

Is a bone marrow harvesting painful?

There is a mild localized discomfort associated with aspiration. At The STEM CELL Orthopedic Institute of Texas, we use IV light sedation and most patients mid this to be very acceptable. The bone marrow aspirate procedure usually takes less than 10 minutes.

Do you take bone marrow aspirate from more than one site in the hip?

It will depend on the amount of bone marrow aspirate your physician believes will provide a good preparation. So, sometimes two sites might be needed.

What if I have anemia?

If you have a hematocrit below 30 or a hemoglobin below 10, we may not be able to perform the procedure. If your hematocrit is between 30-36 or your hemoglobin below 12, we may try to limit IV blood or marrow amounts and will have you follow up with your family doctors.

Why can’t I be on certain medications during the procedure?

Certain types of medications will decrease the effectiveness of the STEM CELLS.

What if I take Coumadin, Plavix or other blood thinners?

Based on national recommendations, we will make a recommended of when to stop your blood thinner. If you take baby aspirin, then you would need to come off this one week before the procedure.

 

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