27 November 2024
On November 13th, the Champalimaud Foundation's Haemato-Oncology Unit performed the first haematopoietic transplant, also known as a bone marrow transplant. The Champalimaud Clinical Centre has thus become the first centre in the last decade to receive approval from the IPST (Portuguese Blood and Transplant Institute) to carry out this procedure.
The patient has multiple myeloma, one of the most common haematological (blood) cancers worldwide.
In patients under the age of 70, the first-line treatment for this cancer includes harvesting the patient's own cells, known as “haematopoietic progenitor cells”, intensive chemotherapy and, finally, reinfusion of the previously harvested cells. These haematopoietic progenitor cells are capable of giving rise to all types of blood cells normally produced by the bone marrow.
Why is this necessary in multiple myeloma? Because the intensive chemotherapy will irreversibly destroy the bone marrow. And only the reinfusion into the same patient (autotransplantation) of previously harvested and preserved haematopoietic progenitor cells can regenerate it.
Today, these cells are harvested from peripheral blood and not directly from bone marrow. “Classically, bone marrow transplantation consisted of harvesting the cells directly from the bone marrow, but nowadays this is no longer the case,” explains Paulo Lúcio, director of the Haemato-Oncology Unit. “What we call a bone marrow transplantation is, strictly speaking, a transplantation of haematopoietic progenitor cells, harvested from the peripheral blood, to repopulate the bone marrow.”
“The chemotherapy carried out between the harvest and the re-infusion of the cells, called “intensification”, aims to eradicate most of the cancer cells that remain after an initial pre-transplant chemotherapy, called “induction,” explains Paulo Lúcio.
“This patient's haematopoietic progenitor cells were harvested about a month ago,” he continues. “The cells were cryopreserved at minus 196 degrees centigrade. And after the intensive chemotherapy, on November 12th, in a single session – that destroyed the bone marrow – the patient received a transplant of his own haematopoietic progenitor cells the very next day.
The patient was hospitalised in a room at the Champalimaud Clinical Centre equipped to receive immunosuppressed patients, who are very sensitive to infections. “The patient recovered well and was discharged from the hospital 13 days after the transplant”, adds Paulo Lúcio.
The ability to harvest and infuse haematopoietic cells into patients opens the way to future cell therapies against cancer – and in particular, to the use of so-called CAR-T cells. These cells are produced by taking T cells from the patient and manipulating them in the laboratory so that they display proteins on their surface that recognise cancer cells and destroy them.
In recent years, several CAR-T cell therapies have been approved by the Food and Drug Administration (FDA) and the European Medicine Agency (EMA). All of them are aimed at treating blood cancers, including lymphomas, some forms of leukaemia and multiple myeloma.
“One of the great advantages for us in starting to transplant cells,” says Paulo Lúcio, “is that it gives us mastery of a procedure that will be necessary to carry out therapies such as CAR-T cell transplants in the future.”
