Before I was diagnosed with multiple myeloma in 2010, medical science was not my field of expertise, but rather my wife’s. She is a pediatric endocrinologist and had taught me about pediatric diabetes and other metabolic disorders.  

I, on the other hand, was an expert in municipal law. I also had developed an expertise in construction accidents because, for eight years, I had been working with a New York City government agency that regulated construction. I was responsible for editing many of the reports on construction accidents that affected the public, and the agency’s structural engineers patiently taught me the basic principles of construction safety.

The focus of my studies changed with my myeloma diagnosis.

After I was told that I would need a stem cell transplant, I read the various booklets and articles the medical team provided because I don’t think I had heard of a “stem cell transplant” before. I may have heard of bone marrow transplants but certainly could not distinguish between the two.  

After reading all the material, I only got a rudimentary idea of the procedure. I knew that there were four basic steps:

First, before the transplant, some of my own stem cells would be “harvested” over the course of a couple of days by putting a needle in my arm, collecting my blood and spinning it through a centrifuge machine. The stem cells would be separated from the other blood components, and the remainder of my blood would be returned to me.

Second, my stem cells would then be frozen until the transplant.

Third, when I was ready for the transplant, I would be given a dose of high-dose chemotherapy that would kill my bone marrow.  

Finally, after the bone marrow was killed, my harvested stem cells would be retrieved from the deep freeze and would be given back to me intravenously. My blood stream would transport the stem cells to my bones, and they would re-seed my bone marrow. My bone marrow, over the course of a few weeks, would grow back and start producing healthy blood cells.  The myeloma would eventually return, but meanwhile any concentrations of it that had existed in my blood or bone marrow would be sharply reduced if not eliminated. 

Over the last few months, I decided to try to learn more about the history of stem cell transplants. 

I read many articles on the web and found the history so fascinating that I decided to try and make a list of some of the major achievements. I could then perhaps understand more of the procedure that I had gone through a couple of months ago. Perhaps I could even explain the process in a bit more detail to my friends who asked.  

After reading these articles and accounts of the development of these procedures, I am simply in awe at the brilliance and persistence of the scientists and researchers involved.  

I am also in total awe at the bravery of the doctors and the patients who were willing to try these new procedures. While tens if not hundreds of thousands of stem cell transplants have now been performed, it must have taken incredible courage to have been involved when the procedure was novel.  

I thought I would share my understanding of some of the main scientific accomplishments that led to this now widely used procedure.  

As I already pointed out, every one of the steps was an extraordinary accomplishment.

Blood stem cell transplants were clinically introduced just 26 years ago, in 1986. They now vastly outnumber bone marrow transplants, where some of a patient’s (or a donor’s) bone marrow is actually removed from the bones and then transfused into the patient’s bloodstream. 

Stem cell transplants account for virtually all autologous transplants (where the patient’s own cells are used) and 75 percent of allogeneic transplants (where a donor’s cells are transplanted). They are far less arduous than bone marrow transplants, which require anesthesia for both the donor and the patient.

Although scientific progress can be divided any number of ways, the articles I read came up with seven or eight critical steps in the development of the stem cell transplant procedure.  In more or less chronological order here is my list:

1. In the 1950’s, scientists discovered that certain cells in the blood were capable of generating other components of blood – red cells, white cells, plasma and platelets. 
2. In the mid-1960’s, an engineer at IBM, whose son was ill with leukemia, oberved the difficulty in collecting white blood cells. Working with researchers at the National Cancer Institute, he and his colleagues at IBM developed a machine that could separate these different blood components from one another on a continuous flow basis. The essential process behind the machine is a centrifuge. It spins the blood, which then separates into layers depending on the component’s’ specific gravity. The collection of the different blood components by the centrifuge is called “apheresis.”
3. At about the same time in the 1960’s, dogs whose bone marrow had been destroyed by radiation were successfully treated with transplants. When the dogs were transfused with cells from their own blood or with cells from other dogs, their bone marrow grew back and their blood was reconstituted. The term “blood stem cell” was coined, as these blood cells can reproduce all types of blood cells, similar to the way that embryonic stem cells can develop into any type of human cell.  
4. In the 1970’s, a successful stem cell transplant was performed in a human. Nevertheless, the process did not quickly come into widespread use as the procedure did not prove reliable. The procedure may not have been consistently successful because insufficient numbers of stem cells from the donors were collected and because the stem cells given to patients did not reconstitute blood cells quickly enough. 
5. In the late 1970’s, a technique called “cryopreservation” was developed that allows stem cells to be collected and stored over an extended period of time. Cryopreservation involves cooling the stem cells to a sub-zero temperature and storing them in liquid nitrogen. By the mid 1980’s, several successful stem cell transplants were performed by collecting stem cells through multiple apheresis procedures and preserving them at low temperatures till needed.  
6. In the late 1980’s, the procedure was further improved by the use of growth factors, which are agents injected into the blood to stimulate the production of stem cells. Results from two clinical trials showed that growth factors increased the production of stem cells 100 fold before the harvest and thus increased the yield of stem cell collection during apheresis.  In addition, growth factors can be given to patients soon after transplant to increase the production of blood cells.  
7. Until the 1990’s, allogeneic (donor) stem cell transplants were not performed because of concerns that the donor stem cells identify the recipient’s cells as foreign and attack them. This problem, called “graft-versus-host disease,” was overcome by the development of a technique called HLA typing that allows doctors to match recipients with appropriate donors. Allogeneic stem cell transplants are now widely used in various blood cancers and other diseases.  
8. Finally, antibiotics and anti-fungal, anti-shingles, and anti-nausea medicines came into use that significantly eased the dangers and discomfort of the transplant process. Destruction of the bone marrow during chemotherapy destroys the immune system and makes patients highly susceptible to infections.  The anti-infectives substantially lowered the infection risk of stem cell transplant patients. 

A huge amount of research and clinical trials is going on now in the various blood cancers.  Similar to what has happened over the past 50 years, the research will assuredly make a huge difference to the next generation of cancer patients – and, hopefully, to us, the current generation.