HJAR May/Jun 2022

HEALTHCARE JOURNAL OF ARKANSAS  I  MAY / JUN 2022 47 immune system will only need a prepara- tive regimen to create some space in bone marrow, but a person with aggressive blood cancer will require a very intense chemotherapy regimen. When deciding on an ideal preparative regimen, doctors consider the risk of failure due to less preparation and risk of toxicity due to an intensive regimen. How is BMT performed? After a patient has received a prepar- ative regimen, bone marrow cells are in- fused into their blood like a simple blood transfusion. Most people are surprised at how simple the procedure is. What are the main complications of BMT? Reconstruction of the immune system and blood puts a person at a very high risk of infections. At the time of BMT, the recipient’s immune system is as good as that of an unborn child. This puts BMT recipients at a very high risk of infections from the environment and bacteria, fun- gus, and viruses that are present in their bodies. Patients are closely monitored for infections until one year after their BMT when infection risk decreases. When a new immune system from a donor attacks the recipient, it’s called graft-versus-host disease (GVHD). Severe GVHD can be fatal and requires close monitoring and prompt treatment. Most patients will recover from immediate side effects of the preparative regimen within two months from BMT. Arunkumar J. Modi, MBBS, MPH Director for Blood and Marrow Transplant and Cellular Therapy Arkansas Children’s Hospital There are long-term side effects fromBMT that require life-long monitoring by spe- cialists. What is cellular therapy? Cellular therapy is when a person’s immune system cells are modified in the lab to make them target a specific protein present on cancer cells or virus-infect- ed cells. chimeric antigen receptor T cell (CAR T cell) therapy against CD19-posi- tive blood cancer can recognize, attack, and kill pre-B-cell leukemia that nor- mally evades immune damage. This has been very successful in clinical trials and is now commercially available. There are many more types of CAR T cell therapies being tested in clinical trials worldwide to target different types of cancer cells. Simi- lar techniques are used to target common viral infections in immune-compromised persons. This is the most modern way to harness the power of the human immune system to kill cancer and virus-infected cells. n Arunkumar (Arun) J. Modi, MBBS, MPH, is an as- sociate professor of pediatrics at the University of Arkansas for Medical Sciences practicing atArkansas Children’s Hospital. He is the director for blood and marrow transplant and cellular therapy at Arkansas Children’s Hospital —Arkansas’only children’s BMT programaccredited by the Foundation for theAccred- itation of Cellular Therapy (FACT). Modi attended medical school at B.J.Medical School inAhmedabad, India,and pursued amaster’s degree in public health at Texas A&M University Health Science Center. He went to Albany Medical Center for a pediatric res- idency followed by fellowship training in pediatric hematology oncology at Cleveland Clinic. He has additional one-year fellowship training in pediatric BMT and cellular therapy from St. Jude Children’s Research Hospital. from closely matched or mismatched do- nors will overcome such a defense and keep blood cancer cells from coming back. Interestingly, when doctors used identical sibling donors for BMT, the cancer was more likely to come back than when using nonidentical donors. Who can be an allogeneic BMT donor? When doctors decide on a donor, they utilize tissue typing or human leucocyte antigen (HLA) typing. This is a group of proteins that are present on all body cells and play a crucial role in interactions with immune system cells. Matching at the tis- sue level helps prevent rejection from the recipient and prevents attacks by the new immune system on mismatched recipient cells, known as graft-versus-host disease (GVHD). An ideal donor is a nonidentical sibling followed by a very close match in the registry of unrelated donors. Doctors can also use a half-match family member like the parents or children of the patient who share half of the same genes. How is the patient prepared to receive BMT? A preparative regimen is usually com- prised of multiple agents of chemothera- py and/or radiation. The primary goals of the preparative regimen are to eliminate the recipient’s immune system and create space in the bone marrow. Preparative regimens are customized to the recipient’s condition. For example, a child without an