Cord blood-derived stem-cell transplantation, allogeneic
HCPCS code
Name of the Procedure:
Cord Blood-Derived Stem-Cell Transplantation, Allogeneic (HCPCS S2142)
Commonly referred to as cord blood transplantation or allogeneic stem cell transplant.
Summary
Cord blood-derived stem-cell transplantation involves using stem cells from the umbilical cord blood of a donor to replace damaged or diseased bone marrow in a patient. This procedure is primarily used to treat various blood disorders, cancers, and immune deficiencies.
Purpose
This procedure addresses conditions such as leukemia, lymphoma, aplastic anemia, and certain genetic disorders. The goal is to restore the patient's ability to produce healthy blood cells and to re-establish a functional immune system, aiming for complete disease remission or significant improvement.
Indications
Cord blood-derived stem-cell transplantation is indicated for patients with:
- High-risk or relapsed leukemias and lymphomas
- Severe aplastic anemia
- Certain inherited metabolic or immune system disorders Ideal candidates often include those who lack a suitable adult bone marrow donor.
Preparation
Patients must undergo pre-transplant evaluation including:
- Blood tests
- Imaging studies
- Bone marrow biopsy
- Cardiac and pulmonary function tests Patients might need to adjust medications and potentially fast before the procedure. Pre-transplant conditioning therapy (e.g., chemotherapy, radiation) is typically required to prepare the body for new stem cells.
Procedure Description
- Collection: Cord blood is collected from the umbilical cord of a newborn donor immediately after birth.
- Processing: The collected blood is processed and stored in a cord blood bank until needed.
- Pre-Transplant Conditioning: Patients receive chemotherapy and/or radiation therapy to destroy diseased bone marrow.
- Transplantation: The processed stem cells are infused into the patient’s bloodstream through an intravenous (IV) line, similarly to a blood transfusion.
- Engraftment: The infused stem cells migrate to the bone marrow, where they begin to grow and produce healthy blood cells.
Anesthesia or sedation is not typically required for the transplantation itself, but may be needed for pre-procedure tests or treatments.
Duration
The actual stem cell infusion lasts about 30 minutes to an hour. However, the entire pre-transplant conditioning process and monitoring can take several weeks.
Setting
This procedure is performed in a hospital setting, often in a specialized bone marrow transplant unit.
Personnel
The team involved includes:
- Hematologist/Oncologist
- Transplant surgeons
- Nurses specialized in bone marrow transplantation
- Anesthesiologists (if sedation is required)
- Laboratory technicians
Risks and Complications
Common risks:
- Infection
- Graft-versus-host disease (GVHD)
- Bleeding
- Organ damage Rare complications:
- Veno-occlusive disease (VOD)
- Secondary cancers Management involves close monitoring, medication adjustments, and symptomatic treatments.
Benefits
Expected benefits include improved blood cell production and immune function. Many patients experience remission of their underlying disease. Benefits can be observed within weeks to months post-transplant.
Recovery
Post-procedure care involves:
- Regular blood tests and monitoring
- Medications to prevent infection and GVHD
- Hospital stay for several weeks
- Restricted activity and regular follow-up appointments Full recovery and immune system normalization can take several months to a year.
Alternatives
Alternatives to cord blood transplantation include:
- Autologous stem cell transplantation (using the patient’s own stem cells)
- Bone marrow transplantation from an adult donor
- Chemotherapy alone Each alternative comes with its own set of risks and benefits, and suitability depends on the individual patient's condition.
Patient Experience
During the infusion, patients might feel minor discomfort akin to a standard IV procedure. Post-transplant, patients may experience fatigue, nausea, and other side effects from the conditioning therapy and transplant. Pain management and supportive care measures are provided to ensure patient comfort.