1. What is stem cell transplantation?
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Bone marrow and peripheral blood stem cell transplants are used to treat blood tumors such as leukemia, multiple myeloma, and non-Hodgkin’s lymphoma. Stem cell transplantation can help restore blood production in the body after patients have received high doses of chemotherapy or radiation therapy. As many as 50,000 patients are treated with stem cell transplants in the United States each year.
2. Why do I need a stem cell transplant?
To kill blood tumor cells.
High-dose chemotherapy or radiation regimens that kill blood tumor cells can also kill healthy bone marrow cells, and stem cell transplantation can help restore blood production in the bone marrow. In some patients, an eventual cure can be achieved with treatment related to stem cell transplantation.
3. Should stem cell transplantation be the preferred treatment for hematologic tumors?
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Stem cell transplantation is not usually the first treatment option. The starting treatment for hematologic tumors is usually chemotherapy or chemotherapeutic agents combined with targeted and immunotherapy, and medical experts often disagree about which therapy should be used.
Stem cell transplantation is one of the more expensive and risky options, and is mostly considered after chemotherapy has failed. However, in some cancer centers, stem cell transplantation is also tried as a starting treatment option.
4. Where do stem cells come from?
There are several types of sources of transplanted stem cells:
- Bone marrow transplantation is the replacement of bone marrow with healthy bone marrow tissue that has undergone malignant lesions;
- Peripheral blood stem cell transplantation is the collection of stem cells from the blood for transplantation;
- Transplant donors can be the patient’s own cells (autologous transplant) or stem cells donated from volunteers (allogeneic transplant).
5. Can umbilical cord blood be used for transplant treatment?
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Stem cells can also be from the umbilical cord blood of a newborn. Some families store cord blood in case of emergency, and cord blood can also be donated for public use. For patients who have not been able to find a matching donor among close relatives within the family, voluntary cord blood donation is a source for obtaining suitable stem cells.
6. How do I find a matched donor?
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Some patients can use their own stem cells, while others must rely on a relative or volunteer donor, and finding a genetically matched donor is key to performing a transplant.
If the transplanted cells will attack the patient’s own cells or if the patient’s immune system will attack the transplanted cells, both can cause serious problems. In North America, for example, it is easy for whites to find unrelated stem cell donors. But African-Americans and Asians, because of the low number of volunteer marrow donors, have a much more difficult time finding matched stem cell donors.
7. How do you collect stem cells?
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The collection of bone marrow requires the donor to be put under general anesthesia and then the bone marrow is extracted from the iliac region using a needle, a procedure that takes 1 to 2 hours in the operating room.
A few days before donating peripheral blood stem cells, doctors give the donor special medications to raise the level of stem cells in the blood. The donor’s blood vessels are then connected to an instrument to collect the stem cells from the donor’s blood and transfuse the rest back into the patient.
8. What is a microtransplant protocol?
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There is a newer treatment option for elderly and seriously ill patients who cannot tolerate traditional stem cell transplantation. Stem cell microtransplantation uses a reduced-intensity pretreatment regimen that kills some of the tumor cells. Moreover, the patient’s immune system is suppressed, allowing the transplanted stem cells to survive.
This regimen requires only lower doses of radiation and chemotherapy, but may not be as effective as traditional transplantation regimens in halting tumor progression.
9. What is the transplant process like?
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The prep for stem cell transplantation is complex, but the treatment process is simple. Preparing to perform a stem cell transplant is a very difficult task:
- The first step is to go through a lot of medical testing to try to find a donor that is a match for the patient.
- Patients need to receive high doses of chemotherapy and radiation prior to transplantation.
- The transplant process is really quite simple.
- The transplant process is actually very simple. The patient does not need anesthesia and the collected stem cells are infused intravenously into the patient’s body and into the bloodstream, which takes about 1 to 5 hours.
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10. How long do I have to stay in the hospital after transplant?
After a stem cell transplant, patients need to be hospitalized for 2 to 6 weeks to wait for the new stem cells to begin to function as a hematopoietic agent. During this time, the patient’s blood counts are very low, so he or she will be closely monitored and may receive a prophylactic dose of antibiotics, antifungals, and antivirals to avoid life-threatening, serious infections.
11. How often should I be rechecked after discharge?
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Transplant patients may need to undergo relevant clinical examinations daily or weekly for several months after discharge from the hospital. These include blood tests, chest x-rays, and bone marrow testing. During recovery, patients may also receive frequent blood transfusions and antibiotics, and will need regular follow-up visits for up to a year until the body’s immune system is working properly.
12. What are the risks associated with donating bone marrow or stem cells?
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Bone marrow donation is a more complex medical procedure. The pain in the donor’s iliac region typically lasts for several days, and it takes 4 to 6 weeks for the donated bone marrow cells to gradually return to their pre-donation levels. In rare cases, bone marrow donors may develop serious infections or complications from anesthesia.
Peripheral blood stem cell donors may face problems with clotting, catheter-related problems, and side effects from medications used to boost peripheral blood stem cell counts.
13. What are the long-term effects of transplantation on patients?
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Transplantation can save patients’ lives. However, many survivors will need to face other clinical problems years later, often related to the specific transplant procedure, or the medications used in the transplant. Clinical problems include organ damage, altered hormone levels, infertility, nerve damage, and the development of other types of tumors. Studies are looking at ways to reduce these long-term risks and improve the quality of life for patients with hematologic tumors.