Stem Cell Transplant 101

[ag2006]

Stem Cell Transplant
From MayoClinic.com - Special to CNN.com
SOURCE http://www.cnn.com/HEALTH/library/CA/00067.html AND
http://www.mayoclinic.com/health/ste...splant/CA00067

When you think of a transplant, you may have an image of a major surgical procedure to replace a diseased organ. But stem cell transplants don't involve surgery. And the "organ" involved is bone marrow — not a solid organ such as a liver.

If your bone marrow stops working, your body won't produce enough healthy stem cells. And that means you may not have enough healthy white blood cells, red blood cells or platelets, putting you at risk of life-threatening infections, anemia and bleeding.

A stem cell transplant is the infusion of healthy stem cells into your body. If all goes well, these healthy stem cells take hold in your body and begin normal production of blood cells.

Although the procedure is generally called a stem cell transplant, it's also known as a bone marrow transplant or an umbilical cord blood transplant, depending on the source of the stem cells.

What are the reasons for a stem cell transplant?

Stem cell transplants are used to treat people whose stem cells have been damaged by disease or treatment of a disease. Stem cell transplants can benefit a variety of both cancerous (malignant) and noncancerous (nonmalignant) diseases.

For instance, in aplastic anemia, a noncancerous condition, your bone marrow stops making enough new blood cells. A stem cell transplant destroys the dysfunctional marrow, and healthy stem cells are infused. If all goes well, the new stem cells migrate to the marrow and begin working normally.

Similarly, in leukemia, the unhealthy bone marrow is destroyed because it doesn't work properly and may contain cancer cells. When healthy stem cells are transplanted, normal cell production can resume. In addition, immune factors in the transplanted cells may help destroy any cancer cells that remain in your bone marrow.

How do you prepare for a stem cell transplant?

Usually you remain at home until your transplant is actually scheduled. During that time, your health care team may recommend that you work on building up your strength and maintaining a healthy diet.

Pretransplant tests and procedures

Once donor stem cells become available, you undergo many tests and procedures to assess your health and the status of your condition, and to ensure that you're physically prepared for the transplant.

In addition, an intravenous (IV) catheter is typically surgically implanted, usually in your chest near your neck. This is often called a central line, and it usually remains in place for the duration of your treatment. It's through the central line that the transplanted stem cells will be infused. The central line is also used to collect blood samples, give chemotherapy, provide blood transfusions and even supply nutrition when necessary.

The conditioning process

After you complete your pretransplant tests and procedures, you begin a process known as conditioning. During conditioning, you undergo chemotherapy and possibly radiation in order to:

Destroy cancer cells

Suppress your immune system so that your body doesn't reject the transplanted stem cells

The type of conditioning process you undergo depends on a number of factors, including your disease, overall health and the type of transplant planned — whether you get stem cells donated from someone else (allogeneic transplant) or whether the stem cells come from your own body (autologous transplant).

Conditioning generally occurs in the week leading up to your stem cell transplant. In some cases, you receive high doses of chemotherapy and total body irradiation (TBI). On the other hand, you may receive only high doses of chemotherapy and no radiation at all. The type of conditioning you undergo depends on your unique circumstances.

The conditioning process may be done in the hospital or on an outpatient basis. It can cause numerous side effects and complications because your bone marrow and stem cells are destroyed in anticipation of the transplant, and even if your conditioning process is outpatient, you may need hospitalization for side effects.

Side effects of the conditioning process can include:

Nausea and vomiting
Diarrhea
Hair loss
Mouth sores or ulcers
Infections, such as pneumonia
Bleeding
Infertility or sterility
Premature menopause
Anemia
Fatigue
Cataracts
Organ failure, such as heart, liver or lung failure
Secondary cancers

You may be able to take medications or other measures to reduce such side effects.

'Mini' stem cell transplants

A less intense conditioning process is available through what's known as a "mini" stem cell transplant. It's also called a reduced-intensity conditioning transplant or a nonmyeloablative transplant.

Reduced-intensity conditioning doesn't try to kill all of the cancer cells that may be in your body. Instead, it relies on the donor's immune system cells to fight your cancer cells.

A less intense conditioning regimen may seem attractive because it may pose fewer life-threatening complications. But this kind of transplant isn't appropriate for all situations. Mini stem cell transplants are typically used only for people who can't endure the harsher conditioning regimen, such as older adults or people in poorer health, and for people whose disease isn't rapidly progressing. In some cases, they may not be as successful as full transplants.

What can you expect during a stem cell transplant?

Stem cell transplants are typically performed in specialized medical centers. These centers generally have dedicated transplant units, with a team of specialists caring for you. This team often includes doctors, transplant nurses and coordinators, mental health professionals, occupational therapists and dietitians.

Stem cell transplantation involves infusing, or injecting, donor stem cells through your central line. This usually takes one to five hours. The transplanted stem cells make their way to your bone marrow cavities, where they begin creating new bone marrow and stem cells. It can take several weeks, though, for your blood counts to begin recovering.

If you receive bone marrow or blood stem cells that have been thawed, you may notice an odor wafting in your room for a day or two after the transplant. This is caused by the substance used to preserve the cells.

Just before the transplant, you may have received medications to reduce the side effects the preservative can cause. These side effects include:

Nausea
Fever
Chills
Hives

Not everyone experiences side effects from the preservative, and for some people those side effects are minimal.

What happens after a stem cell transplant?

As you wait for your new stem cells to begin functioning, you will be at risk of such complications as infections and bleeding. In addition, you may still be recovering from problems related to conditioning.

Depending on your treatment protocol, you may stay in the hospital until your blood counts recover or you may return home but remain under close medical care. Some people who have inpatient transplants are able to leave the hospital within three to five weeks, but others may face much longer hospitalizations. Some transplant facilities require transplant recipients to remain nearby for 100 days to allow close monitoring.

In the days and weeks after your stem cell transplant, you may have many of the same kinds of tests and procedures to monitor your condition that you had before the transplant. You may also need supplemental nutrition to compensate for nausea and diarrhea.

To combat various complications, you may need to take numerous medications. You may also need periodic transfusions of red blood cells and platelets until your bone marrow begins producing enough of those cells on its own.

It usually takes about a full year for your blood cells and immune system to recover to normal levels. In general, recovery from a stem cell transplant that uses your own harvested stem cells is quicker than one that uses donor stem cells.

Preventing infections

During hospitalization and once you return home, you must take special precautions to prevent infections.

These precautions include:

Wearing a filtration mask to protect against airborne bacteria and viruses

Avoiding contact with people who have any symptoms of illness, including colds

Avoiding crowds

Avoiding zoos, parks and areas heavily populated with birds

Not swimming or using a hot tub

Having someone else clean your home, particularly bathrooms and sinks

Be alert for signs of infection and report them immediately to your health
care team. Such signs may include feeling ill, loss of appetite, nausea, fever, runny nose, sore throat or cough.

Home-based care

With your blood counts recovering, you should begin feeling better. Mouth sores and diarrhea may go away or become less severe. Your appetite may improve and you may begin feeling physically stronger. Even after you go home, you'll need regular medical care to monitor your condition, though. Your health care team will provide instructions about any special care or precautions to take once you're home.

Emotional and lifestyle issues

The diagnosis of a life-threatening illness can generate enormous stress for you and your family. Coping with side effects, prolonged periods of isolation, low energy and limited activity can lead to feelings of anger, grief and depression. These are normal responses to a prolonged and sometimes difficult treatment period.

Members of your health care team can address the emotional aspects of your stem cell transplant. Physical and occupational therapists can advise you on relaxation, increasing your endurance and exploring new activities. Mental health professionals, social workers and chaplains can help you cope with anxiety and depression, and help you remain positive.

What are the risks of a stem cell transplant?
A stem cell transplant poses many risks of complications, some potentially fatal. Although some people experience few problems with a transplant, others must endure frequent tests and repeated hospitalizations.

Complications that can arise with a stem cell transplant include:

Graft-versus-host disease
Stem cell (graft) failure
Organ damage
Blood vessel damage
Cataracts
Secondary cancers
Death
Balancing the pros and cons of a stem cell transplant

A stem cell transplant can cure some diseases and put others into remission. Most people who have a stem cell transplant expect the procedure to extend their life, and it often does.

Some people sail through stem cell transplantation with few side effects and complications. Others experience numerous problems, both short- and long-term. The severity of side effects and the success of the transplant vary from person to person.

Most people who have a stem cell transplant and don't have a relapse of their disease go on to enjoy a good quality of life. Many are able to return to work or school and resume their normal activities.

Before having a transplant, make sure you understand the risks and benefits, and how your own situation will affect your transplant experience.

SOURCE http://www.cnn.com/HEALTH/library/CA/00067.html AND
http://www.mayoclinic.com/health/ste...splant/CA00067

****************
Here's another article entitled Stem Cells: Sorting Through The Hype & Hope

[ag2006]

THREADS ON SCT FROM THIS FORUM

-SCT Wisdom at the Midnight Hour

-Stem Cell Transplant Tips (Thread)

-Help/Question re SCT

-SCT Thread from the NHL side

-SCT-Tell Me More Thread

-Relapse 101 Thread

WEBSITES:

Stem Cell Tranplant Info, CLICK HERE

SCT by NHL Family (lots of good info) CLICK HERE

Stem Cell Collection: Apheresis CLICK HERE

I hope others will join in and include their SCT/BMT experiences and tips here to help other patients about to face this treatment.

Best Wishes,

Anne

[SweetTea2]

Good info will put in favorites to save, hopefully I never need!!

Thanks,
Joanna

[skylin]

bump for darrel

[ag2006]

Before I leave on vacation tomorrow, I wanted to post this information to all the newbies who are preparing for a stem cell transplant (SCT) or who are going through one right now. It's guidebook called "Survivor's Guide for Bone Marrow/Stem Cell Transplant" from the The National Bone Marrow Transplant Link. It has some very helpful information about what to expect during a SCT and how to get through it. I wish I found this guidebook prior to my own SCT - Click HERE to read this guidebook[/b].

There is also a "Resource Guide for Stem Cell Transplants - Friends Helping Friends" also by the National BMT Link website, which is very informative.

Additionally, here are two links for Caregivers:

1. Caregiver's Guide for SCT/BMT by the National BMT Link

2. TIPS for Caregivers by UCSD

Good luck to all the newbies going through the SCT/BMT process.

Best Wishes,

Anne

[RayNat]

Anne is back, yeah!!! So glad to see you posting and helping those who need it most!!! Great compilation - way to go; enjoy your vacation!!

[RayNat]

Anne is back, yeah!! So good to see you go beyond anything or anyone and help those who need it most! Great compilation -- enjoy your vacation!

[ag2006]

7 Phases of the Transplant Process
Source: http://www.bmtresources.org/seven_phases.htm

Transplants have about seven phases:
[*] Determining if you are a bone marrow or stem cell transplant candidate[*] Deciding the treatment that's best for you[*] Selecting a transplant center[*] Preparing for your transplant[*] Doing your transplant[*] Recovering from chemotherapy and/or radiation treatment[*] Maintaining your health post-transplant

1. Determining if you are a bone marrow or stem cell transplant candidate.

There are now millions of people in the U.S. who have diseases or disorders that are treatable with BMTs or PBSCTs. The National Marrow Donor Program lists over 70 diseases and disorders.

You can click on the TX by Disease navigation button in the left column and review a list of over 70 diseases for which bone marrow transplants and stem cell transplants have been performed.

Here are four Web sites you can visit to learn if you’re disease makes you a bone marrow transplant or stem cell transplant candidate:

National Marrow Donor Program
http://www.marrow.org

National Institutes of Health Clinical Trials Database
http://www.health.nih.gov

Mayo Clinic
http://www.mayoclinic.org/bone-marro.../diseases.html

U.S. Department of Health and Human Services Health Resources and Services Administration
http://www.hrsa.gov/osp/dot/treat.htm

The National Health Information Center has a very good page Questions and Answers page on their site. Go to http://cis.nci.nih.gov/fact/7_41.htm.

You can also try typing the name of your disease or disorder and the word association in the search box of your browser (i.e. anemia + association). Many disease-specific associations and organizations can tell you if transplants are being used as a treatment option.

Age is almost never a factor in bone marrow or stem cell transplantation. Transplants are preformed on kids and senior citizens alike.

2. Deciding the treatment that’s best for you.

Your doctor will decide whether you should enter a clinical trial or if an individualized treatment plan is best.

If at all possible, visit a doctor who specializes in your disease. You can search for doctors by specialty at People Living with Cancer (http://www.peoplelivingwithcancer.org) and the American Medical Association (http://www.dbapps.ama-assn.org).

Want to do some investigative work?
You can go to http://www.cancerfacts.com and use the NexCura NexProfiler Treatment tool. It's free.

The Bone Marrow Foundation (http://www.bonemarrow.org) has an Ask the Expert feature on their Web site. You can privately e-mail your transplant questions to a medical professional.

You can also do some research at the National Institutes of Health site (http://www.health.nih.gov). You can search the Clinical Trials database.

The National Cancer Institute (http://www.cancer.gov) has a guide entitled How to Find a Cancer Treatment Trial. It’s free and can be read online or downloaded for printing.

3. Selecting a transplant center.

There are over 200 centers in the country that do bone marrow and stem cell transplants. Some specialize in specific diseases, like the Myeloma Institute for Research and Therapy.

You can go to the National Marrow Donor Program’s site (http://www.marrow.org) and review profiles of every center in the country.

BMTInfonet (http://www.bmtinfonet.org) offers visitors an online Transplant Center Search form.

The Coalition of Cancer Cooperative Groups (http://www.cancertrialshelp.org) is another excellent resource. They have TrialCheck®, a cancer clinical trials search engine to assist in finding trials right for you.

4. Preparing for your transplant.

There are a number of steps you will take to prepare for your transplant. These steps include:
[*] Getting your central line (catheter) if you don’t already have one[*] Doing pre-conditioning chemotherapy and or radiation[*] Receiving shots of G-CSF (a drug to stimulate stem cell proliferation) if you’re doing an autologous transplant[*] Having your bone marrow harvested or stem cells collected (again, if you’re doing an auto transplant).[*] Oncolink (www.oncolink.com/coping) offers “A wealth of knowledge to help patients deal with the side effects of cancer treatment such as nausea, vomiting, fatigue, infection, and pain.”[*] Go to the American Cancer Society’s home page (http://www.cancer.org) and click on the word Coping. Then click on Preparing for Treatment.[*] The Leukemia & Lymphoma Society (http://www.leukemia-lymphoma.org) has a booklet entitled Understanding Drug Therapy and Managing Side Effects. This free publication can be mailed or read online.

5. Doing your transplant.

Transplants themselves are easy as pie. With a bone marrow transplant, the marrow is pushed into your central line over a matter of minutes. Stem transplants are done by letting the cells drip into your central line. No muss. No fuss.

Many Autologous BMTs and PBSCTs are being done on an outpatient basis.

Want to talk to someone who has your disease and has done a transplant? Go to the Cancer Survivors Network (http://www.acscsn.org) or the Association of Cancer Online Resources (http://www.acor.org) and you can do just that.

6. Recovering from chemotherapy and/or radiation treatments.

You’ll be at the greatest risk for infection while your immune system is depressed from the chemo or radiation or both. This period usually lasts several weeks.

The National Cancer Institute (http://www.cancer.gov) has a free publication Chemotherapy and You: A Guide to Self-Help During Cancer Treatment. You’ll learn what to expect and how to deal with side effects and complications. It even covers nutrition.


7. Maintaining your health post-transplant.

Your transplant center will give you a detailed set of instructions when you are discharged. Follow them to the letter.

You can get additional information from the Cancer Research Institute (http://www.cancerresearch.org). Their book, What to do if Cancer Strikes, has a chapter on Taking Charge of the Future.

The National Comprehensive Cancer Network (http://www.nccn.org) has a number of free Patient Guidelines. Go to their site and click on Patient Guidelines. Scroll down to the Supportive Care section. Select the Fever and Neutropenia guide.

You can download in PDF or order a printed copy sent by mail.

______________________________
Best Wishes,

Anne

[SarahSmile]

Great stuff, Anne! Here's a link to another thread which contains many, many great links and resources -- it's awesome!

SCT Tips

[ag2006]

Awesome info! - Thanks Sarah...the more we know, the better prepared we are. Thanks to Pinesoul for starting the SCT tips.

Adding two recent articles to this mix:

1. Bringing The Curative Power Of Stem Cell Transplants To More Patients - How A New Mouse Model Shows The Way and

2. Majority of Patients Report Good Long-Term Quality of Life Following Stem Cell Transplants

Best Wishes,

Anne