Stem Cell Transplant: Why This Treatment Is Still a ‘Standard Regimen’ for Blood Cancer

Despite the exciting new therapies available for patients with blood cancers, both autologous and allogeneic stem cell transplants remain a powerful and necessary treatment modality.

Dr Matthew Matasar, chief of Division of Blood Disorders and hematologist/oncologist at Rutgers Cancer Institute, and professor of medicine at Rutgers Robert Wood Johnson Medical School, said that despite the wave of newer therapies for patients with hematologic cancers, transplant has stood the test of time.

“It used to be that we had trouble finding donors for many patients, and now it is more often the case that we have a wide range of potential sources of stem cells for a donor, for a recipient in need of a transplant,” Matasar said in an interview with CURE. “The challenge for clinical teams is not finding a donor, but in choosing the best of a range of options.”

RWJBarnabas Health and Rutgers Cancer Institute, based in New Brunswick, New Jersey, recently celebrated its 30th anniversary of its Transplant and Cellular Program. In an interview with CURE, Matasar highlighted the role of transplant in 2025 and the shifts the treatment has made in the last 30 years, explaining why it remains a standard regimen in today’s practice.

How has stem cell transplant care changed over the last 30 years, and what are the best new donor options for blood cancer patients?

We have seen a dramatic evolution in our capabilities to treat patients with blood cancers with bone marrow transplantation over these last 30 years. Originally it was called bone marrow transplant, and now we largely speak of this as stem cell transplant. That's one major evolution — it is a broadening of the sources by which we can achieve cells for donation.

We've gone from requiring a sibling donation to having a wide range of potential donors for most patients. We now look at patients who need a stem cell transplant and can use not just a matched sibling or an unrelated donor from around the world, but can even turn to other family members, such as parents or children who are genetically a half match and use that as a source of stem cells. Even under circumstances, we can use blood that has been banked from umbilical cords, from births that has been banked and saved, and the very rich stem cells in those umbilical cord blood units can be used as a rich source of stem cells for a life-saving stem cell transplant.

What are the newest, most exciting advances in allogeneic stem cell transplant, and what should patients know about preventing graft-versus-host disease (GVHD)?

One of the greatest challenges historically with allogeneic stem cell transplant has been this tightrope that we try to walk as transplanters. We understand that if the weight tips too far in one direction and the new immune system is too active, that new activated immune system can injure the recipient's body.

This is a process of graft — the donated stem cells — versus host, the person in need of the transplant. Graft versus host has been a long challenge. In the other direction, if we suppress the new immune system to counteract that too far, then we have a suppressed immune system which further predisposes to risks of infections. This tightrope walk has always been the challenge that we walk within allogeneic stem cell transplantation as a discipline.

One major advancement in these last years has been the rise of cyclophosphamide, and we have learned that using this old chemotherapy in lower doses after a transplant can achieve a stabilizing of this tightrope walk, and can dramatically lower the risks of graft-versus-host disease and allow us to walk a safer path in those early days after a transplant.

How does autologous stem cell transplant compare with CAR-T cell therapy for relapsed lymphoma and multiple myeloma?

So far in this conversation, we have been largely focusing on donor stem cell transplantation, allogeneic stem cell transplantation. There is, of course, another field of transplant, of autologous stem cell transplantation, which is using your own stem cells, as opposed to a donor's stem cells. Autologous transplant is still used even here in 2025 for patients, particularly facing diagnoses of lymphoma or multiple myeloma. This field too is seeing rapid change, and we're doing fewer of these autologous stem cell transplants, particularly for aggressive lymphomas like Munson's [McLeod], in favor of other treatments such as CAR-T cell therapy.

CAR-T cell therapies are treatments in which we take out a patient's healthy T cells — not their stem cells, but healthy immune cells from the bloodstream — and can genetically re-engineer them to recognize and attack cancer cells, like [Munson’s] aggressive lymphoma. We found, in many contexts, that CAR-T cell therapy can be both safer and more effective than the traditional autologous transplant for some patients at highest risk of being failed by that transplant technique.

We still do autologous transplants for patients with lymphoma and multiple myeloma, but we are having this paradigm change afoot where we have a wider range of options and we can better personalize and tailor our treatments for an individual patient's diagnosis, treatment, journey and story.

When should a patient with aggressive lymphoma or blood cancer be referred to an academic cancer center for a transplant consultation?

The most important thing to educate patients, their families and community oncologists on when looking at the care of patients with aggressive B-cell lymphoma is the importance of an early referral to an academic center with a transplant and cellular therapy program. There is this reluctance of "Oh, I don't want to be a burden to that oncologist. I'm sure they're busy with sicker people than me." Or for the community oncologist, "I don't want to refer a patient who doesn't need immediate treatment."

Our perspective as transplant experts is we want those relationships with patients, their families and community oncologists as early in the course of care as possible. Nothing makes me happier than meeting a patient and saying, "We've got your back, and I hope I never need to meet you again." But the opportunity to have those counsels early allows us to be thoughtful and collaborative. [We want to have] shared care of their illness, so that if things don't go according to plan, if questions or concerns arise, or if God forbid a relapse occurs, [we can do] rapid initiation of next line treatment and take care of problems while they're still more readily solvable.

What makes your NCI-designated cancer center's Transplant and Cellular Therapy Program unique?

I am tremendously proud of the program that we have developed here at the Rutgers Cancer Institute. Yes, we are the only NCI-designated cancer center in New Jersey. We have a robust transplant and cellular therapy program, in which we perform all kinds of stem cell transplant from self and from donors, all kinds of cellular therapy, including standard treatments with FDA-approved cellular therapy and gene therapies for illnesses such as sickle cell and related diseases.

We also are helping lead nationally and globally clinical trials deploy next-generation treatments that may offer the promise of even greater cure rates and hopefully less toxicity. All this is in service to our patients in the community, so I'm tremendously proud of my colleagues in the program and tremendously focused on our mission of serving New Jersey and the country beyond so that we can put cancer behind us.

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