Patients with leukemia, lymphoma, multiple myeloma, amyloidosis, and myelodysplastic syndrome often need a stem cell transplant (also known as bone marrow transplant, or BMT) to treat their blood cancer. Patients with other blood disorders like aplastic anemia, sickle cell disease, or beta thalassemia may also benefit from a stem cell transplant, in some cases combined with gene therapy.
Stem cell transplants are extremely complex because patients need to have their diseased blood cells wiped out before they can be replaced with new, healthy cells. This is done using chemotherapy, either alone or in combination with radiation therapy. The replacement cells can be from the patient (called an autologous transplant) or from a donor (called an allogeneic transplant).
Stem cell and bone marrow transplants don’t just require an expert medical team. BMTs also require strong emotional support for patients, who often spend long periods of time in the hospital and must manage many side effects. Memorial Sloan Kettering Cancer Center (MSK) is a leader in providing care to patients undergoing BMTs.
Medical oncologist Miguel-Angel Perales, MD, Chief of the Adult Bone Marrow Transplant Service, explains why MSK’s BMT program continues to be a leader in the field of transplantation. In addition to his role at MSK, Dr. Perales served as president of the American Society for Transplantation and Cellular Therapy from 2023 to 2024.
1. MSK has the largest BMT program in the New York City area.
MSK has the biggest and most experienced BMT program in the New York metropolitan area by far — it’s also one of the largest BMT programs in the country. “In 2024, our adult BMT program performed 555 transplants — the most we’ve ever done,” Dr. Perales says. “We also treat many children and teenagers through our MSK Kids pediatric BMT program.”
Since their beginnings, the adult and pediatric BMT programs at MSK have performed more than 10,000 transplants.
Through MSK Kids, MSK is the first hospital in New York City to offer gene therapy for sickle cell anemia and beta thalassemia. In addition, MSK’s Cellular Therapy Service offers treatments like CAR T cell therapies. CAR T treatments use a patient’s own immune cells to recognize and fight cancer.
2. MSK has experts focused solely on stem cell and bone marrow transplants.
“A big reason we are recognized as leaders in the BMT field is that everything we do is a team effort. We say this so often that it sounds like a cliché, but it’s true,” Dr. Perales says. “We have many care providers whose only focus is people receiving BMTs and cell therapies.”
Members of the BMT team work with many other experts across the hospital. “I don’t think there’s a single department within the hospital that BMT doesn’t touch,” he adds. “In many ways, the strength of this program is the strength of the whole institution.”
3. MSK’s BMT team includes medical professionals and scientists working in many different areas.
- The BMT team includes doctors who focus primarily on patient care as well as those who focus more on clinical or laboratory research.
- The team also includes physician assistants, nurse practitioners, and registered nurses who work exclusively in the BMT program. They form close, personal connections to patients going through this therapy.
- Clinical care coordinators, who are also nurses, focus on getting patients ready to have their transplants.
- The BMT program has a dedicated group of pharmacists, as well as experts in diet and nutrition.
4. MSK has specialists caring for all the medical needs of people undergoing stem cell transplants.
The BMT team relies on many members of MSK’s Division of Subspecialty Medicine — doctors who focus on providing general medical care to people being treated for cancer.
BMTs can affect many systems in the body. MSK has pulmonologists, gastroenterologists, cardiologists, dermatologists, kidney specialists, and others who have specialized expertise in the challenging complications that can arise around BMTs. These experts care for patients before, during, and after their stem cell transplants.
“We work especially closely with MSK’s infectious diseases experts,” Dr. Perales notes, “including those who see only BMT, cell therapy, and leukemia patients. Because of the type of chemotherapy used for blood cancers, patients may be severely immunocompromised. Infections are always a big concern.”
5. MSK has unique programs for BMT patients that may not be available at other hospitals.
MSK has a clinic dedicated to treating graft-versus-host disease (GVHD), a serious complication of BMTs that use donor cells. Graft-versus-host disease occurs when the donor’s immune cells attack healthy tissues in the recipient. The GVHD clinic is co-led by hematologic oncologist Doris Ponce, MD, MS; pediatric hematologist-oncologist and BMT specialist Andrew Harris, MD; and dermatologist Alina Markova, MD.
MSK has developed processes to make stem cell transplants more effective, including through graft engineering, in which the immune cells called T cells are removed. T cells from the donor can cause GVHD; by removing them, doctors can reduce the risk of this complication.
Doctors at MSK have found ways to reduce the impact of toxic chemotherapy that patients are given before their stem cell transplant, reducing some of the side effects from BMT treatments. This is done by adjusting the dose of the drugs to the specific patient, called precision dosing.
6. MSK has ways to help patients without a fully matched stem cell donor.
Many people who need a stem cell transplant from a donor are not able to find someone who is fully matched. Finding a matched BMT donor is especially a challenge for people who have southern European, Asian, African, Hispanic, Middle Eastern, or mixed ethnic backgrounds. These groups tend to be underrepresented in public registries.
MSK has pioneered ways to find stem cell donors for patients who don’t have someone who is fully matched, through the alternative donor program, which is led by BMT specialist Brian Shaffer, MD.
Alternative sources of stem cells for transplants may include:
- Volunteer donors who are not a perfect match (mismatched unrelated donors)
- A family member who is only half-matched, such as a parent or child (haplo-identical donor)
- A cord blood transplant, which uses stem cells from the umbilical cords of newborns that have been donated to a cord blood bank
These approaches to finding alternative stem cell donors have saved many patients at MSK. “When I consult with a BMT patient today, one of the first things I say to them is, ‘I am confident we will find you a donor,’ ” Dr. Perales says.
7. MSK’s research strives to improve BMTs and make them more accessible.
MSK has nationally recognized research efforts focused on new ways to make stem cell transplants more effective for more people. One major challenge is controlling the disease well enough so patients are healthy enough to undergo a transplant. “We are getting better at preparing patients for a BMT, by using newer chemotherapies as well as targeted therapies and immunotherapies,” Dr. Perales says.
8. MSK also treats rare cancers with stem cell transplants.
While BMTs typically treat common blood cancers like leukemia, lymphoma, multiple myeloma, and myelodysplastic syndrome, they can also treat less common disorders, including severe aplastic anemia, systemic amyloidosis, and central nervous system (CNS) lymphoma. MSK has experts who specialize in treating these rare cancers with transplants.
9. MSK offers BMT care at many locations outside of Manhattan.
People having BMTs can receive some of their care at our regional sites, including MSK Commack and MSK Nassau on Long Island, MSK Westchester, and MSK Monmouth in New Jersey.
MSK’s facility in Brooklyn, Memorial Medical Care, PC, also houses dedicated bone marrow transplant experts. “We are excited that we are available to more patients who live in New York City but find it difficult to travel into Manhattan,” Dr. Perales says.
10. MSK has been a leader in providing innovative BMT treatments for more than 50 years.
In 1973, MSK pediatric oncologist Richard O’Reilly, MD, pioneered the field with the development of the first-ever bone marrow transplant for a pediatric patient without a sibling who was a full match. The patient received bone marrow from an unrelated donor who was found to be a match. This groundbreaking achievement dramatically expanded treatment options for patients of all ages with blood cancers — not just at MSK, but worldwide.
Key Takeaways
- MSK has the biggest and most experienced BMT program in the New York metropolitan area, and one of the largest BMT programs in the country.
- MSK has experts focused solely on stem cell and bone marrow transplants, including those who offer supportive care throughout the transplant process.
- MSK is a leader in research that seeks to make bone marrow and stem cell transplants more widely available.
- MSK has many transplant options for patients who don’t have a fully matched stem cell or bone marrow donor.
