The Bone Marrow Transplantation Department at the Sheba Medical Center is an integral part of the Hematology Division at the hospital. The department has 14 patient beds situated in modern private rooms, an outpatient treatment unit, patient clinic, a pheresis-stem cell collection and freezing service, a clinical laboratory, a research laboratory, and a cell treatment and immunotherapy unit. The department is located, on the 5th floor, West Wing, of the Charles Clore Hospitalization Tower at the Sheba Medical Center.

Treatment offered in the department includes conventional chemotherapy, autologous bone marrow transplantation after high dose chemotherapy, allogeneic bone marrow transplantation (from a HLA tissue matched sibling donor), bone marrow transplantation from a matched unrelated donor (MUD), haploidentical bone marrow transplantation from a partially HLA matched tissue related donor, mini bone marrow transplantation (RIC, NST) which makes transplantation for the elderly, and stem cell transplantation possible and cord blood transplantation. Immunological treatment with cytokines, cell treatment, inoculations and single clone antibodies (immunotherapy) are also offered.   

To date approximately 2000 bone marrow transplantations, hematopoietic stem cell collections and immunotherapy and immunology treatments have been performed at the BMT department at Sheba.  In 2004 198 BMT procedures were performed at Sheba.

The BMT department at Sheba is at the forefront of treatment for Leukemia, Lymphatic and Solid malignant tumors and is a leader in the field both in Israel and on an international level. BMT for non-malignant diseases, of which some are genetic and congenital and some metabolic related, is also performed. Recently treatment of autoimmune diseases has been performed in cooperation with Prof. Yehuda Schoenfeld, a world renowned expert on autoimmune diseases and Dr. Anat Achiron an international expert on Multiple Sclerosis (MS).
Innovative Specialist's Clinics for other medical disciplines that are necessary to support patients post BMT have been opened recently. One of these clinics is headed by Dr. Dror Meirov, an international expert in the field of post BMT fertility. The clinic also offers the services of gynecology, pulmonary, infectious disease (ID) and hepatic disease specialists.

The department is a member of and is recognized by the European Bone Marrow Transplantation - EBMT and the International Bone Marrow Transplantation Registry - IBMTR, both international Autologous, Allogeneic, MUD, Haploidentical and Cord Blood Transplantation organizations. The department is also a member of the National Marrow Donor Program - NMDP, an international organization for Allogeneic BMT from an unrelated tissue matched donor.

The department meets international criterion for BMT performance, and participates in and presents on a regular basis at international conferences on BMT and scientific publications and research on the subject.     

Treatment at the department is offered to the patients on an individual basis, and patients enjoy the personal attention of the staff twenty four hours a day. Patients are hospitalized in private rooms, accessorized with television sets hooked up to satellite broadcasts, stereo music, computer, telephone, a refrigerator and other accessories that make the stay more pleasant for the patient and his or her family. 

The department offers a spacious fully accessorized family room for the use of the families of patients. A support group to help the patients deal with the complex treatments they are undergoing is also active. In addition, an innovative treatment utilizing "painting" therapy has become an integral part of the treatment offered by the staff. A volunteer group has also been organized to support Russian speaking patients and patient with special needs. Hotel Apropos and Shimon House also offer their services to the families of patients.
From a medical standpoint the department offers a wide range of BMT transplantation procedures and treatments.

• Autologous BMT
In cases where no donor has been located or the patient's clinical status does not allow or does not require transplant from a donor we perform transplant from stem cells taken from the patient and cryo-preserved. The transplant is usually produced from peripheral blood.

• Allogeneic BMT
From an HLA tissue matched sibling or related family member, the stem cells are from peripheral blood, bone marrow or cord blood. 

• Allogeneic BMT from an unrelated donor
When no matched donor is located within the family, the stem cells comes from an unrelated tissue matched donor. This kind of transplant can be performed when the donated graft is from the bone marrow, peripheral blood or cord blood. 

Ms. Ayelet Vigoda, the transplant coordinator, assists in locating a potential donor
Ms. Ayelet Vigoda Tel:  03-530-5727 Fax: 03-530-5377

• Mismatched Allogeneic BMT and Mismatched Haploidentical BMT
In these cases the tissue match may be only 50%, as in Haploidentical BMT. In cases of transplant from a family member with a 50% tissue match, the graft is taken from the peripheral blood after hematopoietic stem cell isolation and refinement using special columns. In cases where the donor is not a family member only a minor level of tissue mismatch is acceptable.

Stem Cells

The stem cells used for the transplantation may be from a number of sources:

1. Stem Cell Mobilization
The donor's blood is tested and sub-cutaneous G-CSF injections and cell mobilization by pheresis is performed. The number of cell mobilizations is determined by the number of stem cells required.
Cell mobilization is a simple process, takes only a few hours, and is similar to the procedure for blood or platelet donation at the blood bank. The process is performed at the Cell Mobilization Service at Sheba.

2. Bone Marrow Harvesting in the Operating Room
This procedure requires that the donor undergo examination and testing and an anesthesia consultation prior to the harvesting procedure, and it is necessary for the donor to be hospitalized. Today this procedure is not performed in most cases.

3. Umbilical Cord Blood Harvesting
This procedure requires that the cord blood gathered after birth is tested, and the blood is usually cryo-preserved in a Cord Blood Bank.

4. Graft Manipulation
In some cases the graft requires treatment for removal of tumor cells or T cells. Almost total removal of the T calls is performed by isolating the hematopoietic stem cells (+CD34) and it is a prerequisite for successful transplantation from a mismatched donor. This procedure is performed today using special columns (separation device) and other separation techniques.    
 
The Donor

Bone marrow donation or peripheral blood or cord blood donation for transplantation are not risky procedures and they require only a few hours to complete. An Allogeneic Stem Cell donor, whether related or otherwise, tissue matched or mismatched, or partially matched, must perform the following blood tests: biochemistry, coagulations tests and virology.

Successfully locating a donor is performed by searching the unrelated Data Bank, Registries of the Cord Blood Bank and locating the donor as fast as possible by our well trained, experience and professional stuff.

This is the responsibility of Ms. Ayelet Vigoda (Tel: 03-5305727  Fax: 03-530377)  the search coordinator for Sheba.

Pre-transplantation

Prior to transplantation the patient undergoes extensive evaluation to determine his or her clinical and physical status, and to ascertain if the patient is in optimally good condition prior to transplantation.

This evaluation and testing includes blood test, chest x-ray, electrocardiogram, imaging procedures such as CT scan, Gallium and Bone Scan, MRI, bone marrow aspiration and bone biopsy (if indicated), molecular evaluation, gynecological evaluation, dental treatment, cardiac function tests (MUGA and ECHO), pulmonary function testing, and referral for specialist consultation (if a problem such as abnormal liver or kidney function test results is discovered) and possibly insertion of Hickman or Peakline Catheter which is done in our Radiology Department.

The evaluation is usually performed on an ambulatory basis, and is coordinated with the transplant Coordinator Ms. Ronit Ovadia. 

The Pre-transplantation Conditioning

The chemotherapy before transplantation called conditioning. Conditioning involves chemotherapy with or without irradiation. Treatment with the most modern transplantation procedures, mini-transplantations (RIC, NST) or reduced intensity transplantation is based on temporary immune suppression and does not involve irradiation or high dose chemotherapy. Four factors govern the decision regarding the conditioning regiment: the patient's condition, the disease status, the type of transplantation and the level of tissue matching between the donor and patient. 

Post Transplantation

A period of ambulatory treatment follows the transplantation and includes close patient monitoring, and testing and treatment at home and at the out patient transplantation Clinic. The treatment also includes immunotherapy (immunological) treatment with cytokines or lymphocyte cells.

Department at a Glance
Number of Beds - 15
Number of Patients per Year - 4500
Director - Prof. Arnon Nagler Specialist in Internal Medicine, Hematology and Bone Marrow  Transplantation, and International Specialist in Cord Blood  Transplantation.  Advanced training in Hematology & Transplantation at Stanford University,  (U.S.A.)   Prof. Arnon Nagler has headed Tel Hashomer (Sheba) Cord Blood Bank since 2001. Pioneer and world acclaimed leader in field of umbilical cord blood, cord blood banking and stem cell separation and treatment. Professor Nagler is founding member of  NetCord and EuroCord (the European network of cord blood banks and transplants) and is a formal cord blood inspection of the FACHT/NetCord organization. Professor Nagler's cord blood bank at Sheba Medical Center was recently accredited by the NMDP.   Among Dr. Nagler's myriad of awards, his most recent include the Best Abstract Award from the American Society of Bone and Marrow Transplantation (ABSMT) in February 2004 and the Best Abstract from the National Marrow Donor Program Meeting in October, 2004. Professor Nagler has received over forty grants from government, research associations, foundations and pharmaceutical companies for his ongoing research. He holds over forty patents and trademarks, has been the lead investigator on over fifteen clinical trials, is an international sought-after lecturer, and widely published. His tenure with leading edge biotech and pharmaceutical companies included his role as Technical Leader and Medical Advisor to Gamida Cell. Dr. Nagler is a Professor Medicine at Tel-Aviv University, Director of Hematology at Chaim Sheba Medical Center, Tel-Hashomer and is also Director of Bone Marrow Transplantation and the Cord Blood Bank. Dr. Nagler served as a fellow in medicine/hematology at Stanford University School of Medicine from 1986 until 1989 and is a member of the American Society of Hematology.
Staff - Director - Prof. Arnon Nagler  Specialist in Internal Medicine, Hematology and Bone Marrow  Transplantation, and International Specialist in Cord Blood  Transplantation.  Advanced training in Hematology & Transplantation at Stanford University,  (U.S.A.)    Tel: 03-530-5830 Mobile: 052-6667-180 Fax: 03-530-5377   Head Nurse – Ms. Sigal Torati Tel: 03-530-5301  Dept. Tel: 03-530-5303   Physicians   Dr. Avichai Shimoni Specialist in Internal Medicine, Hematology and Bone Marrow  Transplantation/ Advanced training at the Bone Marrow Transplantation Center of MD  Anderson (U.S.A.) Email: avichai.shimoni@sheba.health.gov.il   Dr. Izhar Hardan Specialist in Hematology and Bone Marrow Transplantation. Email: izhar.hardan@sheba.health.gov.il   Dr. Ronit Yerushalmi Specialist in Internal Medicine, Hematology and Bone Marrow  Transplantation. Advanced training at the Bone Marrow Transplantation Center in Denver,  Colorado (U.S.A.) Email: ronit.yerushalmi@sheba.health.gov.il   Dr. Noga Shem-Tov Specialist in Internal Medicine, Hematology and Bone Marrow  Transplantation. Email: noga.shemtov@sheba.health.gov.il
Address - West Wing, The Charles Clore Hospitalization Tower
E-mail - Arnon.Nagler@sheba.health.gov.il
Tel - 972-3-530-5830