Bone Marrow Transplant / CAR-T

Bone marrow (haematopoietic stem cell) transplantation and chimeric antigen receptor T-cell (CAR-T) therapy are advanced cellular treatments for blood cancers and selected non-malignant haematological disorders. In allogeneic transplantation, the patient first receives conditioning chemotherapy and/or radiotherapy to ablate diseased marrow and immunosuppress them, then donor stem cells (from bone marrow, peripheral blood after G-CSF mobilisation, or umbilical cord blood) are infused intravenously and reconstitute the haematopoietic and immune system. Autologous transplantation uses the patient's own previously harvested stem cells to rescue marrow after high-dose chemotherapy. CAR-T therapy is a more recent approach in which the patient's T-cells are collected by apheresis, genetically engineered ex vivo to express a chimeric receptor recognising a tumour antigen (commonly CD19 for B-cell malignancies), expanded and re-infused. NHS England commissions licensed CAR-T products for selected relapsed/refractory acute lymphoblastic leukaemia, large B-cell lymphoma and multiple myeloma at designated centres. Both therapies are intensive: transplant inpatients spend 3-6 weeks in protective isolation while neutropenic and platelet-dependent. CAR-T patients are monitored for cytokine release syndrome and neurotoxicity for at least 14-28 days. International patients require lengthy stays (commonly 6-12 weeks) and close follow-up for graft-versus-host disease, infection and disease response. Long-term survival depends on disease type, remission status and donor matching. Sources: NHS Clatterbridge, NHS England HSCT commissioning policy, NHS Great Ormond Street Hospital, UCLH, PMC peer-reviewed literature.