Patients and their families should be aware of the following factors before deciding to undergo a hematopoietic stem cell transplant.
First, one needs to understand what a hematopoietic stem cell transplant is
Tumor or abnormal cells are removed from the recipient’s body through high-dose radiotherapy pretreatment, and then autologous or allogeneic hematopoietic stem cells are transplanted into the recipient to allow the recipient to rebuild a normal hematopoietic and immune system.
Second, understand what are the indications for HSCT
Hematopoietic stem cell transplantation remains a high-risk treatment to date, and is currently used primarily for the treatment of malignant hematologic diseases, but also for non-malignant and non-hematologic diseases, such as severe refractory autoimmune diseases and solid tumors.
- Hematologic tumors: acute leukemia, chronic granulocytic leukemia, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, multiple myeloma, myelodysplastic syndrome, etc.
- Hematologic non-malignant neoplasms: aplastic anemia, Fanconi anemia, thalassemia, sickle cell anemia, myelofibrosis, paroxysmal sleep hemoglobinuria, etc.
- Immune diseases: severe combined immunodeficiency, severe autoimmune diseases, etc.
Again, the need to understand the costs associated with hematopoietic stem cell transplantation
- For autologous transplantation, the cost of hospitalization is typically around $10 to 150 000.
- Sibling HLA-compatible allogeneic transplantation, the initial hospitalization cost is typically around $200,000 to $300,000.
- Non-sibling allogeneic transplantation and haploidentical transplantation, the first hospitalization cost is typically around $200,000 to $400,000.
- Cord blood transplantation, which costs around $300 to $400 million.
How do I choose a transplant center?
- It is better to choose an experienced and reputable transplant center that is located in a large general hospital with a full range of departments, so that if any complications occur, the medical staff will be able to detect and deal with them in a timely manner and improve the success rate of the transplant.
- The choice of accommodations near the hospital makes it easier for family members to care for the patient and to travel to and from the hospital for examinations and treatment.
- How is the overall cost of treatment controlled at the transplant center? Out-of-town patients also need to apply for foreign medical insurance settlement in advance.
- If receiving a non-blood transplant, you should also inquire whether the center is a collection hospital and transplant hospital on record with the Chinese Bone Marrow Bank.
Are patients psychologically prepared?
When facing a transplant, as with the most important events in life, mental state is important.
During this time, patients may feel scared and helpless about transplantation, confused by a lot of medical jargon; they may feel anxious, self-pitying, and even angry that their body has betrayed them and jealous of those who are healthy; they may have mood swings, often struggling with hope and fear; and they may appear to be in denial of reality and feel uncertain about the future.
These are all normal reactions. Please understand and be kind to yourself; after all, patients are facing the most difficult choice they have ever experienced. Think of transplantation as a fresh start to life, a challenge that brings hope and comfort.
Understand and accept the possible complications after transplantation
Recurrence of primary disease
Recurrence is mainly related to the high number of leukemia or hematologic tumor cells remaining in the body at the time of transplantation and the weak anti-leukemia/tumor effect of the graft after transplantation.
Acute and chronic graft versus host disease (GVHD)
Graft versus host disease, commonly known as rejection, is a systemic immune inflammatory response in which donor-derived immune cells attack the patient’s normal tissues and organs.
- Acute graft-versus-host disease, commonly known as acute rejection, usually occurs within 100 days of transplantation and manifests mainly as rash, diarrhea, and jaundice.
- Chronic graft-versus-host disease, commonly referred to as chronic rejection, usually occurs 100 days after transplantation and manifests mainly as fibrosis and atrophy of the affected organs, often similar to the manifestations of autoimmune diseases, mainly scleroderma, dry syndrome, chronic diarrhea, chronic liver disease, and pulmonary fibrosis.
Infection
Post-transplantation, due to low immune function, the chance of various bacterial, fungal, and viral infections is higher than that of healthy individuals, so it is important to go to the hospital at the first sign of infection.
Impact on sexual development and fertility
Transplantation before puberty affects development in both sexes, with delayed puberty, and girls can develop primary ovarian failure, which may require cycle replacement therapy with sex hormone analogs. After transplantation in adult males, most are azoospermic, and a few can gradually regain sperm production. Total body irradiation and some chemotherapy regimens render most infertile, but a few retain fertility.
If you wish to have children after transplantation, you can freeze sperm in men and egg cells in women before transplantation.