Haematopoietic stem cell transplantation (HSCT) is a treatment where blood forming stem cells collected from the bone marrow, peripheral blood or umbilical cord blood are infused into a patient immediately after a patient is given chemotherapy and/or radiotherapy. It is offered to selected patients with blood cancers to improve their treatment outcomes. It is also used to treat certain non-cancerous conditions such as aplastic anaemia and other bone marrow failure syndromes.
Depending on the disease, HSCT can be done using a patient’s own stem cells (autologous HSCT) or from a donor (allogeneic HSCT). A donor could either be a sibling, another family donor (like a son or daughter) or an unrelated donor.
HSCT enables high dose chemotherapy +/- radiotherapy to be given to a patient to treat a cancer, as the blood forming function of the marrow can be rescued by infusion of these stem cells. In an allogeneic transplant, it also allows for the donor’s immune cells to be transferred to the patient. These donor cells will continuously conduct surveillance for any residual cancer cells through a phenomenon known as "graft vs leukemia (or graft vs tumour)" effect. For patients with bone marrow failure syndromes such as aplastic anaemia, HSCT replaces the empty marrow with donor’s healthy haematopoietic stem cell.
HSCT is an effective but intensive treatment for treating various diseases of the marrow and lymphoid system. Not all patients with these diseases need a transplant, as there are non-transplant options for most disease. It depends on disease factors such as stage, risk stratification and prognosis. Equally important are patient factors such as medical and psychological fitness. Every patient for consideration for HSCT requires an individualized and careful weighing of benefit against risk, to decide whether this is the most suitable option for each patient.
Some of the diseases which HSCT may offer a cure or prolonged remission include acute leukemia, chronic leukemia, myelodysplastic syndrome, myelofibrosis, multiple myeloma, lymphoma, and aplastic anaemia.
The first adult HSCT in Singapore was performed in July 1985 at SGH. Since then, our program has grown together with medical advancement in this field. To date we have done more than 1700 transplants, averaging 80-100 transplants annually for the past few years. The HSCT program is a multi-disciplinary program involving many specialties. It consists of haematologists, nurses, pharmacists, laboratory processing technologists and apheresis staff, as well as many supportive services such as infectious disease physicians, radiation oncologists, physiotherapists, dieticians, social workers, etc. The process of coordinating between patients and related donors as well as unrelated donors from the local Bone Marrow Donor Program and overseas programs are overseen by our team of transplant coordinators.
The number of HSCT that we have done since the inception of our program is shown in the chart below. Besides a steady increase in the number of patients transplanted over the years, the source of donors has also diversified over time from conventional bone marrow matched siblings to now include matched unrelated donors, haploidentical (half-matched) donors and unrelated umbilical cord blood donations.
Our transplant success rate is comparable to that of large transplant centres internationally and our department is one of the leading transplant centres in Asia.
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