Freqently Asked Questions
Q: What is Peripheral Stem Cell Transplantation?
A: To treat cancer, oncologist may recommend high-dose chemotherapy and stem cell transplantation. The chemotherapy is called "high-dose" because the doses received are from 5 to 10 times higher than the doses given during traditional chemotherapy. Such high doses of chemotherapy destroy cancer cells but also destroy other healthy cells in the body, which divide and reproduce rapidly, such as the cells that line the mouth, stomach, intestine and the bone marrow.
Blood cells, including red blood cells, white blood cells and platelets, are essential to life. Red blood cells carry oxygen from the lungs throughout the body to all the organs and return carbon dioxide to the lungs to be exhaled. White blood cells prevent and fight infections and platelets help the blood clot. Stem cells are the cells that develop into red blood cells, white blood cells and platelets. Stem cells are concentrated in the bone marrow in bones like the hips, sternum and skull. Stem cells can also be found in the blood that circulates within the body (peripheral blood). Stem cells are the only adult cells that can give rise to more than one cell type.
After the high-dose chemotherapy destroys the stem cells, the body will have less ability to carry oxygen. Patients are also at a high risk of infection and bleeding problems. For these reasons, stem cells must be collected from the patient's own blood or a donor's blood so that they can be given to the patient (transplanted) after his or her treatment. Autologous patients donate their own cells prior to high dose chemotherapy. Allogeneic patients usually have their donors give cells on the day of transplant.
High-dose chemotherapy is the treatment used to destroy cancerous cells, while peripheral stem cell transplantation is necessary to "rescue" damaged bone marrow. Stem cell transplantation is what allows physicians to give high doses of chemotherapy, which are more effective in treating cancer than conventional treatment.
Q: What is a Bone Marrow Transplant?
A: A bone marrow transplant is very similar to a peripheral stem cell transplant. The difference is the source of stem cells given to the patient to help his or her body recover after high-dose chemotherapy. In a peripheral stem cell transplant, stem cells are stimulated to divide and enter the blood from which they are collected. In a bone marrow transplant, the stem cells are harvested from bone marrow located in the hipbones. Additionally, bone marrow transplant patients have a delayed time to engraftment; 21 to 28 days for bone marrow versus 10 to 12 days for peripheral stem cells. The chemotherapy used in either transplant is the same, so the cancer fighting ability is the same.
Q: What are the advantages of peripheral blood stem cell transplant?
A:
- Stem cells from the peripheral blood are generally easier to collect because they do not require general or epidural anesthesia. After a bone marrow collection, a patient also will have some pain and tenderness in the hips for several weeks.
- After a peripheral blood stem cell transplant, the white blood cell and platelet counts usually return to normal several days sooner than after a bone marrow transplant. This reduces the risk of serious infections and bleeding problems.
Q: What is reduced intensity or non-myeloablative allogeneic transplant?
A: One of the most recent advances in the treatment of certain cancers is the use of reduced intensity or non-myeloablative transplant. This type of transplant does not use high-doses of chemotherapy. Instead, lower doses of chemotherapy (mini-doses), with or without radiation, are given pre-transplant followed by infusion of donor stem cells. The donor's stem cells are not given in order to replace the destroyed marrow cells (as in a high-dose transplant) because these are not completely destroyed using the lower doses of chemotherapy. The cells are given in order to create a graft-versus-malignancy effect. The graft (donor's cells) recognizes the cancer (malignancy) as foreign and attacks it. Sometimes, another infusion of donor cells is given after the transplant in order to induce the graft-versus-malignancy effect as well. This is called a donor leukocyte infusion or DLI. Either bone marrow or stem cells can be used in a mini-transplant.
Q: What type of transplant is right for me?
A: Transplants can be divided into several categories. These include:
- the source of stem cells in the body (peripheral blood, bone marrow or cord blood).
- the donor (autologous-self or allogeneic-donor).
- allogeneic donor (is the donor related or unrelated)
- is high-dose or reduced intensity and/or radiation used.
There are many factors that determine the appropriate type of transplant and chemotherapy for each patient. Your physician along with the rest of the transplant team will thoroughly evaluate your past treatment, disease history and current health before they decide which transplant you will receive. If you have any questions regarding your transplant, feel free to ask your transplant physician.
Q: What about costs?
A: RMCC will provide potential transplant patients with financial information about the costs of a transplant. A transplant financial coordinator will obtain information about a patient's insurance coverage and will start to determine if the insurance company will be willing to pay for the cost of the procedure. It is a good idea for patients to determine what insurance coverage they have for the procedure. Approval for payment of transplant expenses by the insurance company does not mean that a patient will have to have the transplant. Knowing the financial arrangements for the costs of a transplant can help patients in the decision making process. Patients should not be discouraged if their insurance company initially declines to cover the cost of transplant therapy. Often they only need more specific information to understand why a patient is an appropriate candidate for this treatment and how important it is to the patient's well being. We will work with the insurance company to provide them with the information that they need. We will keep each patient informed of the progress that we are making. Financial arrangements related to treatment will be determined prior to starting collection of stem cells.
Q: How is a stem cell transplant done?
A: There are several steps to receiving a stem cell transplant. Our team will work with patients and their caregivers during each step of the process to assure the best possible outcomes. The steps are:
- Initial evaluation
- Induction chemotherapy
- Pre-mobilization evaluation
- Central venous catheter (CVC) placement
- Mobilization
- Stem cell collection
- Pre-transplant evaluation
- Preparative regimen
- Stem cell transplant
- Post-chemotherapy
- Engraftment
- Recovery
Q: What happens during an initial evaluation?
A: After carefully reviewing all of the characteristics and aspects of a patient's cancer, the oncologist will determine if the patient might benefit from high-dose chemotherapy with a peripheral blood stem cell transplant at this time. Because the high-dose chemotherapy will cause side effects that could be life threatening, the oncologist must carefully consider what the chances are that this treatment will be beneficial. The oncologist may review a patient's case with a physician specializing in stem cell transplant before deciding whether to recommend this treatment.
If the oncologist determines that this treatment may be beneficial, he or she will discuss this with the patient. A patient's primary oncologist may also recommend that the patient be seen, evaluated and provided more information from a specialized transplant physician and a transplant nurse coordinator.
Q: What is induction chemotherapy?
A: Almost every patient who receives high-dose chemotherapy with a peripheral blood stem cell transplant receives several cycles of regular dose chemotherapy first. This is to determine if the cancer cells respond to chemotherapy drugs and to minimize the number of cancer cells. If the cancer cells are not affected by regular doses of chemotherapy, the chance that high-dose chemotherapy will affect them is usually very small. In many cases, the risks associated with the high-dose chemotherapy are not worth taking if regular doses of chemotherapy have been ineffective. If the regular doses of chemotherapy destroy a large number of the tumor cells, this increases the chances that the high-dose chemotherapy will be able to get rid of most of the remaining cancer cells. The cancer may then be cured or kept away for a longer time.
These courses of regular dose chemotherapy are called induction chemotherapy. They are usually given every two to four weeks. They may last for one or several days. Your oncologist will carefully monitor your reaction to these treatments and how they affect your cancer. These responses will help in developing the best treatment plan for you.
Q: What is mobilization?
A: New advances in technology now allow physicians to increase the number of stem cells in the peripheral blood. This process is called mobilization. Two common methods of mobilization are colony stimulation factors (CSF's) and chemotherapy. CSF's are given daily by an injection for a period ranging from three to fourteen days. If chemotherapy is part of a patient's mobilization, the chemotherapy will be administered at the transplant clinic. After the mobilization treatment begins, the white blood cell count will dip and then will begin to rise. When the patient's white blood cell count reaches a certain level, it will be time to start collecting stem cells from the peripheral blood.
Q:What is the pre-transplant evaluation?
A: The pre-transplant evaluation includes several tests such as a heart scan, EKG, lung function tests, x-rays, blood tests and urine tests. Patients will be asked to have dental x-rays and an exam if they have not recently had one. Some of these tests are done to determine how well certain vital organs function and others are done to check for hidden infections. Once these tests have been performed, the physician or nurse will notify the patient of any abnormal results that would make the transplant inadvisable.
