The Stem Cell Transplantation (SCT) Service in St James’s Hospital was founded in 1984 and has since performed more than 2,500 stem cell and bone marrow transplants. The service oversees transplants in about 160 patients each year. The SCT Unit includes the National Adult Allogeneic Transplant Programme, (allogeneic transplant means using stem cells from a family member or an unrelated matching donor), and an Autologous Stem Cell Transplant Program, (autologous transplant means using your own stem cells). The service is JACIE accredited and is currently the third largest SCT unit in the UK and Ireland. It is affiliated to the European Blood and Marrow Transplantation (EBMT) Registry, it reports all outcomes to the registry and takes part in EBMT research projects.
Stem cell transplants are used to treat and cure many types of haematological, or blood-related, malignancies such as leukaemia, lymphoma or multiple myeloma as well as rare solid-organ tumours. In stem cell transplantation, healthy stem cells are transplanted from one individual to another. Alternatively, the individual’s own stem cells are used. Sources of stem cells include bone marrow and peripheral blood, meaning blood circulating throughout the body. You may hear the procedure referred to as a bone marrow transplant (BMT) or peripheral blood stem cell transplant (PBSCT), depending on the source of the cells that are transplanted.
Post-transplant management is complex and in the first one to two years, is delivered by the transplant team working with your referring doctor. There is a dedicated Long-Term Follow-Up (LTFU) Clinic, which manages transplant-related complications and offers lifelong support to people who have had a bone marrow transplant. Some patients in this clinic received a transplant more than thirty years ago.
In order to identify potential donors, the Transplant Unit works closely with the Tissue Typing Service and the Irish Unrelated Donor Registry (IUBMR), based at the Irish Blood Transfusion Service Board, located on the St James's Hospital campus. It also holds joint SCT planning meetings with paediatricians in the National Paediatric Transplant Unit at Children’s Hospital Ireland at Crumlin.
CAR T-Cell therapy in St. James’s Hospital
Ireland’s first adult CAR T-Cell (Chimeric Antigen Receptor T- Cell Therapy) centre was opened in St James’s Hospital in 2021. The first patient received this therapy in December 2021.
CAR T cell therapy is the most advanced form of cellular immunotherapy currently available for treatment of relapsed B cell lymphoma and B cell acute lymphoblastic leukaemia.
This therapy is a revolutionary development for blood cancer patients, it involves collecting a patient’s own T-cells, which are then prepared for export in the hospital's on-site stem cell laboratory. These cells are then sent overseas to a CAR T manufacturing facility where they are re-engineered to express a receptor to target the cancer cells
In brief, CAR T-cell therapy involves the manipulation of a patient’s own T-cells (lymphocytes) to express receptors (CARs) which will then target the specific cancer cell of interest. This cell therapy enhances the natural ability of T-cells to destroy cancer cells
It is a specialised therapy that requires significant multidisciplinary input to ensure a safe and effective service delivery. Delivery of CAR-T therapy is complex and requires both inpatient and outpatient activity. The multidisciplinary teams involved in patient care includes the haematology medical and nursing and allied health transplant team, supported by the neurology and ICU clinical teams, radiation oncology, radiology, pharmacy, stem cell laboratory, quality and administration and may require input for other specialist’s services as required.
It is expected that use of CAR-T cell therapies will grow exponentially due in part to the development of new products (bispecific CAR T's , allogeneic products) and new indications (low grade lymphoproliferative disorders , multiple myeloma , solid tumours)
The SCT/ CAR-T Service is led by six transplant trained-haematology consultants who each have specific sub-specialist interests and sit on the relevant working parties of the EBMT. The service is delivered by a group of experts called a Multi-Disciplinary Team (MDT). This is a group of doctors, clinical nurse specialists and other health professionals, including pharmacists and laboratory scientists, who specialise in stem cell transplantation. They discuss and manage the patient’s care. The SCT Service is supported by the Apheresis Unit, where stem cells are collected and a Stem Cell Laboratory that has facilities for cryopreservation, or cell storage. (A liquid nitrogen facility is used for the long-term storage of patients’ stem cells).
Stem cell transplantation is carried out in a specialist 21-bed HEPA-filtered unit called Denis Burkitt Ward. The ward is named after Denis Burkitt, an Irish doctor and Trinity College Dublin graduate who described a form of lymphoma/leukemia. The unit is managed by a clinical nurse manager, with a staff of SCT-trained nurses. Specialist support is provided by a team that includes dieticians, physiotherapists, a medical social worker and other medical/surgical teams, as required. Post-transplant care is delivered through the Haematology Oncology Day Care (HODC) Unit, supervised by a clinical nurse manager and specialist haematology nurses.
Patients are referred for transplantation from haematology and oncology consultants throughout Ireland. Patients being considered for transplantation are discussed at a multi-disciplinary planning meeting and reviewed by the consultant and transplant coordinator in a specialist counselling clinic, before embarking on their transplant journey.
The Bone Marrow Leukaemia Trust (BMLT) is a charity founded in 1983 to support the SCT Service. It provides direct support for patients and their relatives and especially recognises the needs of those coming from outside Dublin. Over the last number of years, the BMLT has provided and managed apartments near St James’s Hospital for patients and their families in the first crucial weeks of adapting to life after transplantation. It has also donated equipment, training and staff salaries.
The entire team has extensive experience in stem cell transplantation. Our specialists work closely with each other and collaborate regularly to ensure that your care has the best possible outcomes. All of our haematology consultants have had training in all areas of stem cell transplantation but also have areas of special interest as follows:
JACIE Quality Manager
Medical Secretaries
SCT/CAR-T Coordinators
Clinical Nurse Specialists
ANP
Mr Greg Lee
Ms Kate Saloranta
Allograft: 100 day post transplant follow up form
Annual Post Transplant Follow Up Form
Autograft 100 Day Follow Up Form
Patient Referral Form for Lymphoma MDT
Patient Referral Form for SCT / Car-T Therapy to Lymphoid Team
Patient Referral Form for Stem Cell Transplant Myeloid Team Form
Patient Referral Form for Stem Cell Transplantation to Myeloma Team