Stem Cell Transplantation 101

Friday, August 17, 2012
By, MassKickers

As with any experience, each is personal and unique.  The same goes for one’s stem cell transplant journey.  Though experiences may vary, it is also true that there are some basic issues that all patients and their caregivers should be knowledgeable about before undertaking such a serious treatment.

A stem cell transplant (SCT) is the infusion of healthy stem cells into one’s body.  Because stem cells are infused into the recipient, the more accurate term to describe this process is peripheral blood stem cell transplant (PBSCT).  Stem cell transplants are used to restore the stem cells when the bone marrow has been destroyed by disease, chemotherapy, or radiation.  For patients who have aggressive or refractory types of blood cancers, such as lymphoma, leukemia, and myeloma, a stem cell transplant may be the only hope of a cure.The word “transplant” conjures up thoughts of a large and complicated procedure, like heart or lung surgery. To the surprise of many people, the reality is quite different.  Like a blood transfusion, a stem cell transplant (the infusion of the donor stem cells) lasts but several minutes and is usually uneventful and therefore, anticlimactic.

This treatment is sometimes called a bone marrow transplant (BMT) too, though the usage of this term is quickly becoming old-fashioned.  The term “BMT” harkens back to when stem cells were extracted directly from the donor’s bone marrow.  Though this methodology has been replaced by PBSCT in most institutions, the term endures.  Umbilical cord blood transplant (UCBT) is another type of stem cell transplant.  Whereas the stem cells for a PBSCT come from an adult, stem cells for a UCBT come from the umbilical cord and placenta of a new born baby.   For individuals who are not able to find a suitable unrelated adult donor, a UCBT may be the best hope.

Stem cell transplants are divided into two camps: autologous and allogeneic.  An autologous stem cell transplant is one in which the patient gives his own stem cells to himself.  An allogeneic stem cell transplant is one in which the patient receives stem cells from a related or unrelated donor.   The short-term and long-term risks are considerably higher for an allogeneic stem cell transplant.  In addition to increased risks, the recovery time is also longer usually than for an autologous stem cell transplant.

One of the most common effects of an allogeneic or umbilical cord blood transplant is Graft-versus-Host Disease (GvHD), in which the engrafted donor stem cells attack the patient’s skin, mouth, and gastrointestinal tract.  The severity of GvHD can vary from mild to life-threatening.

A stem cell transplant is the final phase of a more complex treatment plan.  First, the patient receives a conditioning or preparative regimen, which is aimed at destroying the cancerous cells as well as destroys the immune system so that it will not attack the newly infused healthy stem cells.  The conditioning regimen, which can include chemotherapy, radiation or both, is usually harsher than traditional treatment regimens.  As a result, side effects, such as vomiting, diarrhea, mouth sores, lack of appetite, cognitive difficulty, and fatigue, can be more pronounced.  Patients should not feel shy to ask for medication that can lessen the severity of these side effects.  The duration of the conditioning regimen depends on the disease, the patient’s overall health, and age, but it usually lasts from four to ten days.  The goal of the condition regimen should be for the patient to achieve remission if possible before transplantation.  If there is no or little success with a particular regimen, then it may be best for the patient and doctor to try a different conditioning cocktail.  Evidence shows that the rate of relapse is lower for patients who receive a transplant while in remission.

After the completion of the conditioning regimen, a rest day in which no treatment is administered may be given to the patient.  “Day 0” is transplant day.  Thereafter, the days are in the positive column (e.g. Day +30), thereby, indicating how many days passed since transplant day.
It is during the first few days after Day 0 when the patient’s immune system is weakest and susceptible to infection that the side effects caused by the conditioning regimen can be most acute.  It is during this period that the patient will need to look out for and notify his or her medical team of any sudden changes in the body’s appearance.  The speed at which a patient’s blood counts begin to recover varies, but once it does some if not all of these side effects will subside.  When the patient’s absolute neutrophil count (a specific measure of the white blood cells in the blood) reaches a level determined by the medical institution assuming that there are no other problems, the patient will be discharged.
Most hospitals request that transplant survivors remain only a short distance away for at least the first three months in the event that any problems arise.  The first 100 days after transplant are considered critical.  During this period, the medical team may require the patient to visit his or her clinic once or twice a week to monitor progress.

Throughout the patient’s time in the hospital and during the long journey ahead, it is vital that he or she have a cadre of devoted people who can be called upon for help.  From getting home cooked meals to having another pair of ears to keep track of what the doctor says, a close family or friend is critical to the patient’s well-being.
In addition, it is very helpful to find out what complimentary medical resources the hospital offers to those inpatient.  Medical institutions are increasingly offering such diverse complimentary therapies, such as massage, reiki, meditation, musical therapy, and even gentle yoga, to ease the stress of transplantation.  These and other activities can be a great outlet to the patient and the caregiver.

Finally, the patient should bring items from home that help to make his or her stay as comfortable as possible in the hospital.  Whether they’re CDs of one’s favorite music, books, photographs, video games, or a laptop to stay in communication with family and friends, these items can be of enormous emotional benefit.

 

Duane Bailey-Castro Lymphoma survivor and health blogger

Medical Disclaimer
This website is designed to provide additional information to patients and their loved ones when faced with intimidating diagnoses. A physician or medical professional should be consulted before making any health related decisions. We serve as a portal for information so that an informed and efficient decision can be concluded by all parties involved.  The creators of this site are not responsible or liable, directly or indirectly, for any form of damages whatsoever resulting from the use (or misuse) of information contained in or implied by the content of this website. The purpose of the mAss Kickers is to empower people with knowledge, not to specifically advise people how to address each unique situation.

  • Rose

    This is a really intelligent way to answer the questoin.

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