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Resource Guide for Bone Marrow/Stem Cell Transplant
Stem cell transplants are different from other transplants. There’s no surgery for the patient on the day of the procedure. Stem cells are infused intravenously. This occurs in the patient’s hospital room. Many patients and their families, in fact, find the actual day of the procedure to be somewhat anticlimactic. Some of your transplant’s biggest challenges may actually occur in the days leading up to the big event when you receive your chemotherapy and/or radiation.
Just prior to the transplant, you’ll receive high doses of chemotherapy and/or radiation, referred to as a “conditioning regimen” to destroy diseased cells in the body. The chemotherapy and/or radiation will also destroy the stem cells in your marrow, severely weakening the immune system. Until the new cells take over, you’ll be susceptible to infection. Every precaution should be taken to guard against bacterial, viral, and fungal infections. As the stem cells that have been transplanted begin to produce white blood cells, the risk of infection declines. The term “immune compromised” refers to your immune system when it is functioning at less than 100% due to the effects of chemotherapy and/or radiation. This compromised state varies from patient to patient and may last from six months to a year or more after the transplant.
Receiving chemotherapy and radiation is an important part of the treatment and during this time you will be carefully monitored. You can help your medical team during this period by letting them know if you experience anything unusual, and are feeling pain or other symptoms. Be a good communicator. Conversations with your health care team are particularly important at this time.
On the day of transplant, you’ll receive the stem cells that were taken from either you or a donor through an IV (intravenous) just like any blood product or medication. It takes one to two hours for the infusion. In an amazing process, stem cells will travel through the bloodstream and migrate to the marrow space in the bone. They know exactly where to go. The stem cells from the transplant should begin producing lifesustaining blood cells in about two to four weeks. When peripheral blood stem cells or cord blood stem cells are used, this generally occurs somewhat more quickly. You will be monitored frequently for any reaction to the infusion, but in most cases the process is uneventful. While unlikely, it is possible that your body will not allow the stem cells to grow. This is referred to as graft rejection or graft failure, which is a serious complication requiring additional treatment.
It is only natural to wonder about other problems that can arise. Some complications that may occur in the weeks following your transplant are:
In allogeneic transplants, when the cells of the new marrow are from a related or unrelated donor, you may also have complications from graft-versus-host disease (GVHD). This condition occurs when the new stem cells perceive your body as foreign and attack the tissues and/or organs of your body. (“Graft” refers to the donated stem cells and “host” is the patient). This response occurs because, despite the best efforts to have a match, there are some genetic differences between you and your donor. GVHD may compromise the ability of tissues and/or organs to work properly, and it increases the risk of infection. The areas most often affected are the skin, liver, and gastrointestinal tract. GVHD may present itself in either an acute form (within a few months after the transplant) or in a chronic form (up to several months later). This is not uncommon. Severity of GVHD may vary from mild cases of a temporary nature to more serious problems that, in the extreme, can become life threatening. GVHD is managed through a variety of immune suppressing medications that can be administered to control acute and chronic graft-versus-host disease for an extended duration of time.
Although no one would look forward to getting GVHD, a mild acute case may actually be good. It will cause an immune response against any foreign tissue, including any cancer cells in the body that have not been destroyed by chemotherapy, radiation, or the patient’s own immune system. This is why, in some patients, an allogeneic transplant is preferred over an autologous or syngeneic transplant. If patients do not develop GVHD, then their immunosuppressant medication is tapered off in the six months after transplant.
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