Stem Cell Transplants - info: from Cancer Treatment Centers of America

Autologous Stem Cell Transplants
http://www.cancercenter.com/video/treatments-technology/stem-cell-transplants/autologous

This video details autologous stem cell transplants and offers insightful animations of the procedure.

In an autologous stem cell transplant, you are your own donor. Your peripheral blood stem cells are taken from you, frozen until needed, then given back to you after you have received high doses of radiation therapy, chemotherapy, or both, to destroy cancer cells.

"An autologous stem cell transplant removes your bone marrow stem cells so that you can be given larger doses of chemotherapy and radiation. Following therapy, your unharmed stem cells are returned…"

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Autologous Process -

What is it?

In an autologous stem cell transplant, you are your own donor. Your bone marrow or peripheral blood stem cells are taken from you (harvested), frozen until needed, then given back to you (transplanted) after you have received high doses of chemotherapy, radiation therapy, or both, to destroy your cancer cells. At Cancer Treatment Centers of America (CTCA), the majority of autologous transplants are performed using peripheral blood stem cells; the remaining use bone marrow stem cells or a combination of the two.

Indications
Autologous transplants are available for the following diseases:
•Acute myelogenous leukemia, in complete remission
•Acute lymphoblastic leukemia, in complete remission
•Relapsed or primary refractory Hodgkin’s disease
•Relapsed, low-, intermediate- or high-grade non-Hodgkin’s lymphoma
•Standard risk multiple myeloma
•Selected patients with metastatic breast cancer
•Relapsed germ-cell/testicular tumors
•Primary amyloidosis

The first step

The first step is to obtain sufficient stem cells for transplant. Currently, stem cells are mostly obtained from the blood stream (peripheral blood stem cells). In order to move stem cells from the bone marrow to the blood stream, a mobilization treatment is done. You will either receive daily injections of a growth factor for four days, followed by daily stem cell collections, or you will receive moderately high-dose chemotherapy, followed by daily injections of a growth factor. In the latter case, collections will not start until 10-14 days after the chemotherapy.

Collection process

Following mobilization, your white cells and platelets may be very low, and you are at significant risk for infection and bleeding. Collections will be done with an apheresis machine, which is a blood separator. The same machine is used to obtain platelets or plasma at blood centers. You will be connected to the machine through a large-bore catheter, which will be inserted prior to the mobilization chemotherapy. Each collection takes 3-5 hours. Side effects are rare and mostly minor. One to five collections daily are necessary to obtain sufficient stem cells. Each collection will be checked for its stem cell content, and once the threshold goal is reached, the collection process is stopped and the stem cells are frozen and kept in a freezer.


Transplantation

Once sufficient stem cells have been collected, you are ready for the start of the actual transplant therapy. Depending upon your cancer type, either a combination of total body irradiation (TBI) and chemotherapy or a combination of chemotherapy agents are given. Your physician will discuss with you which drugs will be used, and give you a calendar outlining precisely which drugs will be given and when. Many additional drugs will be administered during the days of radiation and chemotherapy. Some are meant to prevent nausea from chemotherapy, some to prevent infections, others to prevent complications from the chemotherapy drugs. Many of the drugs are given to you by mouth, while some are given to you through your vein. You will also receive lots of fluid through your central line to help cleanse your system as quickly as possible.

Two days after the last chemotherapy, your stem cells will be re-infused. After collection, the stem cells were stored in bags in liquid nitrogen to keep them viable. Now they will be thawed at the bedside in a water bath, until they are liquid again. Then the stem cells will be slowly injected with a syringe into your central line. The process lasts 15-30 minutes. Some patients may experience side effects to DMSO (a chemical added to the stem cells to prevent damage during freezing), including but not limited to, nausea and/or shortness of breath.

After the re-infusion of stem cells, it takes about 10-14 days before the first white cells re- appear. In the meantime, the old blood cells will start dying off, and you may be prone to infections and bleeding. Typically, patients will need transfusions of platelets and red cells. Once the white cells and platelets re-appear, they mostly return rapidly to the normal range. Transfusions are usually only needed in the first 2-3 weeks after transplant.

The mobilization phase usually takes place as an outpatient. The actual transplant phase can be done either as an outpatient or as an inpatient. Depending on the availability of a caregiver, your own preferences, and insurance issues, outpatient or inpatient treatment will be recommended.

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A Look at Stem Cell Transplants
http://www.cancercenter.com/video/treatments-technology/stem-cell-transplants/mini-transplant

Using detailed medical illustrations and narration, this video provides an insightful introduction to stem cell transplants. It briefly covers what to expect before, during and after a stem cell transplant.

Included are overviews of autologous and allogeneic stem cell transplants. The video also explains “minitransplants,” which may be a treatment option for some cancer patients.

"When traditional stem cell transplantation is not an option, Cancer Treatment Centers of America may offer a nonmyeloablative or minitransplant. In a minitransplant, lower doses of chemotherapy drugs are used. This lower dosage makes conditioning more tolerable and suppresses your immune system to allow donor engraftment…"

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Allogeneic Stem Cell Transplants
http://www.cancercenter.com/video/treatments-technology/stem-cell-transplants/allogeneic

This video provides extensive details on allogeneic stem cell transplants.

With allogeneic stem cell transplants, a donor provides the healthy stem cells to be transplanted into your body. Family members, oftentimes siblings, are the best matches for donating stem cells for this particular type of transplant.

"In an allogeneic stem cell transplant, your bone marrow is replaced with new healthy stem cells from another person. Stem cells are special parent cells that develop into blood cells and immune cells…"

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Related Links:

◦Learn More About the Autologous Process
http://www.cancercenter.com/stem-cell/stem-cell-autologous.cfm
◦Learn About the Allogeneic Process
http://www.cancercenter.com/stem-cell/stem-cell-allogeneic.cfm
◦Stem Cell Treatment By Disease Type
http://www.cancercenter.com/stem-cell/stem-cell-treatment-disease-type.cfm
◦CTCA at Midwestern Regional Medical Center
http://www.cancercenter.com/midwestern-hospital.cfm