Cancers treated: Hematological (blood) malignancies such as chronic leukemias, lymphomas, and myelomas; also cancers such as neuroblastoma and selected solid tumors
Why performed: High-dose chemotherapy is the best treatment for certain types of cancers. One of the major side effects of high-dose chemotherapy is the destruction of bone marrow stem cells. Stem cell transplants can help restore or replace these cells. Using stem cell transplants in cancer treatment makes it possible for patients to receive very high doses of chemotherapy and/or radiation therapy. In addition, immune factors in the transplanted cells may help destroy any cancer cells remaining in the bone marrow.
Patient preparation: Usually, patients remain at home until the time that the transplant is scheduled. During this time, the patient is often encouraged to build strength and maintain a healthy diet. An important part of patient preparation is researching insurance coverage in order to maximize care. If not nearby, the patient should make arrangements to stay closer to the hospital. It is also necessary to make arrangements for caregiving for up to four months. Caregiving will be needed for help with household chores, grocery shopping, food preparation, medications, central venous catheter care, monitoring of food and fluid intake, companionship, and transportation.
Steps of the procedure: Once donor stem cells become available, many tests and procedures are conducted to ensure that the patient is healthy enough to receive the transplant. A catheter, called a central line, is inserted intravenously in the chest area near the neck. The central line remains in place for duration of the treatment and will be used for the infusion of stem cells. The central line is also used to collect blood samples, administer chemotherapy, and provide blood transfusions and nutrition.
The next step in the procedure is called conditioning and occurs the week before the transplant. During conditioning, the patient undergoes chemotherapy and possibly radiation in order to destroy cancer cells and suppress the immune system to prevent the patient’s body from rejecting transplanted stem cells. Conditioning may be conducted in the hospital or on an outpatient basis. Even if it is conducted as an outpatient, hospitalization for side effects may be required. Numerous side effects may occur, including nausea and vomiting, diarrhea, hair loss, mouth sores or ulcers, infections, bleeding, infertility, sterility, premature menopause, anemia, fatigue, cataracts, organ failure, and secondary cancers. Medications may help reduce side effects.
After the patient is treated with high-dose anticancer drugs and/or radiation during the conditioning process, stem cells are introduced into the patient’s bloodstream intravenously. If the transplant is successful, then the stem cells will migrate into the patient’s bone marrow and begin producing healthy cells.
After the procedure: After entering the bloodstream, stem cells travel to the bone marrow, where they produce new white blood cells, red blood cells, and platelets. This process occurs within about two to four weeks and is known as engraftment. Until the new stem cells begin functioning, transplant recipients will be at risk for complications such as infections and bleeding. Complete recovery of immune function can take several months for autologous transplant recipients and up to two years for patients receiving allogeneic or syngeneic transplants. Doctors conduct various tests to confirm that cancer cells have been eliminated and new blood cells are being produced. Bone marrow aspiration, the removal of a small sample of bone marrow, may be conducted to determine whether the transplant is working. Some patients can leave the hospital within three to five weeks, but others may require longer hospitalization.
Risks: Stem cell transplants are associated with many risks and complications, some potentially fatal. Complications that can arise include stem cell failure, organ and blood vessel damage, cataracts, secondary cancers, and death. Other major risks associated with stem cell transplants are increased susceptibility to infection and bleeding. Stem cell transplant recipients may experience short-term side effects such as nausea, vomiting, fatigue, loss of appetite, mouth sores, hair loss, and skin reactions.
A very serious complication known as graft-versus-host disease (GVHD) may occur when immune cells from the donor attack the patient’s cells. Generally, the most commonly damaged organs in a GVHD response are the skin, liver, and intestines. GVHD is treated with steroids or other immunosuppressive agents.
Results: Stem cell transplants can extend the lives of transplant recipients and cause some cancers to go into remission. Many transplant recipients enjoy a good quality of life and are able to resume their normal activities. Side effects and transplant success vary among recipients, with some patients experiencing very few complications, while others experience numerous problems.
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