What is Bone Marrow Transplantation? – Dr. Michael Y. Shapira

Dr. Michael Y. ShapiraBone Marrow Transplant (BMT) or hematopoietic stem cell transplantation (SCT) is a procedure that transplants healthy bone marrow and immune system into a patient in which those systems are not working properly or as an anti-tumor immune platform (see below).

There are two types of BMT:

· Autologous bone marrow transplantation – A procedure in which bone marrow is removed from a person, stored, and then given back to the person after intensive treatment and

· Allogeneic bone marrow transplantation – A procedure in which a person receives stem cells (cells from which all blood cells develop) from a donor

In some cancers high doses of chemotherapy may be needed to destroy the cancer. However, this may also destroys normal bone marrow and prevents it from making enough blood cells. Without healthy bone marrow, the patient is no longer able to make the blood cells needed to carry oxygen, fight infection, and prevent bleeding. Autologous bone marrow transplantation is used in order to enable this treatment. The patient gets the high-dose therapy and the autologous cells are infused thereafter in order to minimize side effects.

Allogeneic BMT is used when it is necessary to change abnormal blood cell or immune cell production in hereditary or acquired disorders. Additionally, allogeneic BMT is used in various malignant diseases. In malignant diseases, allogeneic BMT combines chemotherapy with an immune process named graft vs. tumor (GVT) effect. In GVT, the foreign, donor immune cells identify the cancerous cells as “foreign” or “non-self” and destroy them.

In certain cases, it is possible to use lower doses of chemotherapy and/or radiation – the GVT will destroy any remaining cancerous cells. This reduced chemotherapy permits the use of the BMT procedure even in patients that are too weak – or too old – to withstand full fledged chemical treatment.

The Department of Bone Marrow Transplantation and Cancer Immunotherapy, Cell Therapy and Transplantation Research Center at the Hadassah Medical Center is one of the leader bone marrow transplantations centers in the world, it characterizes by its constant innovation in approaches and techniques, specially extending the life saving BMT procedures in elderly and medically sick patients. While in other countries the eligibility for such a procedure may be limited to patients under 50 years old, at the Hadassah Medical Center patients well in their 70’s have been treated and healed with this procedure.

Dr. Michael Y. Shapira was born in Jerusalem in 1966. During his medical studies he married Anat and has today 5 children.

In the year 1990 he graduated from the Hebrew university medical school. After volunteering to the IDF, he specialized in internal medicine in the internal medicine wing at the Hadassah medical center in Ein Kerem. Dr. Shapira graduated with honors on 1999 and immediately joined the Bone Marrow Transplantation department in Hadassah as a senior physician. In parallel to his work as a physician, researcher and teacher in the Bone Marrow Transplantation department, he specialized in hematology.

During his work in the Bone Marrow Transplantation department, Dr. Shapira developed the therapeutic and research fields of the department including stem cell transplantation in elderlies, the use of stem cells for organ repair (for example improvement of myocardial damage in congestive heart failure by infusion of autologous bone marrow cells) and treatment of graft vs. host disease (GVHD) using innovative methods including new agents, special procedures and local therapy.

As a senior physician in the Bone Marrow Transplantation department, Dr. Shapira is serving as a principle investigator in several clinical studies.

The treatment with stem cell transplantation in elderly is a major breakthrough in the world of transplantation since until recently; old age (for some procedures above 50 years!) was a contraindication for transplantation. The problem is further augmented as most of the patients in need for transplant suffer from malignant diseases (such as acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), multiple myeloma (MM) etc.) that are much more common as age increase.

Thus, most of the patients in need for stem cell transplantation are excluded from this life saving procedure merely because of age. By the work of Dr. Shapira and his colleagues, it was shown that it is improper to evaluate the patient’s ability to benefit from transplant by chronological age and that other parameters such as performance status, active clinical problems, past medical and surgical history and nutritional state should be used. In this manner, many elderly patients including patients above the age of 70 years underwent allogeneic stem cell transplantation. For this purpose, several innovative treatment protocols were designed that are used for transplantation in elderly patients or other high risk patients.

For his performance as a researcher and teacher, Dr. Shapira received several prizes of excellence.

Dr. Shapira invests his spare time in Jewish studies, practicing Chinese medicine and riding his bicycle.

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