Stem Cell Transplants from Close Matches
Allogenic stem cell transplants are when you receive stem cells that are not your own. Often they may come from a close genetic match, like a sibling. If your family members are not a strong genetic match, IBMT then looks to the national bone marrow registry for a potential donor. Most patients undergoing an allogeneic stem cell transplant have a malignant disease that is sensitive to chemotherapy. It is hoped that administering a much higher dose of chemotherapy will result in a better chance of your cancer remaining in remission. A long remission will ultimately lead to a cure for many patients. Radiation of a part or all of your body may be part of the treatment. Both the high-dose chemotherapy and the radiation will suppress and damage your bone marrow. Inside the bone marrow reside stem cells, which are the "mother" cells that can produce all the cells that are found in your blood: red cells, platelets, and white cells.
Without a stem cell transplant, high-dose chemotherapy and/or radiation would lead to lengthy or permanent low levels of red cells, platelets, and white cells. Consequent risks would include anemia, bleeding and infection.
A stem cell transplant restores the stem cells, which in turn will produce sufficient white cells, platelets and red cells to protect you. At the same time, the new stem cells may start fighting your cancer
Is an allogenic stem cell transplant for you?
You may be a candidate for an allogenic stem cell transplant if you have:
The best donor is a sibling (brother or sister) who is HLA-type (tissue type) identical with the patient. For patients who do not have a suitable related donor, registries of volunteer (unrelated) donors exist.
In this country, The National Marrow Donor Program (NMDP) is the largest national bone marrow registry. Indiana Blood & Marrow Transplantation at Franciscan Health Indianapolis is a transplant center for the NMDP. Worldwide, about 7 million volunteer donors have been registered.
The preferred sequence for selection of possible donors for IBMT physicians is:
- HLA-identical sibling donor
- HLA-matched unrelated donor
- HLA-matched umbilical cord cells mismatched related donor
Once you have completed the pre-transplant process and evaluation, and your donor has been cleared for stem cell donation, the actual transplant episode starts. Often patients are admitted to the Bone Marrow Transplant Unit (4 Tower) of Franciscan Health Indianapolis at the start of the preparative regimen, but increasingly part of this phase is done as an outpatient at the Franciscan Health Cancer Center Indianapolis. Upon arrival on the transplant unit, you can expect your nurse will explain your room to you and obtain a short history. Then your labwork will be drawn and necessary X-rays will be arranged. If you don't already have a central line, one will be inserted in Interventional Radiology, or in the Operating Room.
Once admitted, you will stay in a HEPA-filtered room, to decrease the risk of infection. HEPA stands for “High Efficiency Particulate Air” and means that a filter removes all germs from the passing air. In these rooms, the ceiling of the room contains this highly efficient filter through which all the air enters the room. As long as your white cells are low, you stay in this isolation, but family and friends can visit with you while wearing clean gloves and a face-mask. Visiting hours are from 12 noon to 12 midnight. As long as you are in isolation, you will also have diet restrictions, again to prevent infections. You should not eat fresh fruits or vegetables, or food from outside the hospital. You will use bottled drinking water. As additional measures to decrease the risk of infection, you should not have flowers or plants in your room. Depending upon the disease and the type of donor, either 3 days of radiation (TBI) are given, followed by 2-8 days of chemotherapy, or only 6 days of chemotherapy are used. The irradiation is given twice a day for a total of six doses. The chemotherapy consists of a combination of drugs. Your IBMT physician will discuss with you which drugs will be used, and give you a calendar outlining precisely which drugs will be given and when. Most chemotherapy drugs are given by intravenous infusion. 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 are given by mouth, some are given by vein. You will also receive lots of fluid by vein to help to remove waste products as rapidly as possible. The day before the stem-cell infusion you will start daily infusions of cyclosporine, a drug to try to prevent severe graft versus host disease.
Two days after the last chemotherapy, the stem cells will be infused over 2-3 hours through your central line. This infusion rarely causes any side effects. After the infusion of stem cells, the wait is on for the growth of the new blood cells. It takes about 10-20 days before the first white cells re-appear. In the meantime, the "old" blood cells start dying off, and patients will become prone to infections and bleeding. They will almost certainly need multiple transfusions of platelets and red blood cells. Once the white cells and platelets re-appear, they slowly return to the normal range. Transfusions are usually only needed for the first 3-6 weeks after transplant. As a patient on the transplant unit, you will be expected to participate in your care as much as possible. You should take a daily shower, try to eat in spite of mouth sores, and stay active inside your room. You definitely should avoid spending the entire day in bed just "waiting to get better." Recovering from an allogenic stem cell transplant following an allogeneic stem cell transplant, most patients recover slowly. The mind tends to recover more rapidly than the body, and patients often become impatient with their progress. Half the patients leave the hospital by day 18 after transplant, but discharge does not mean that the process is over.
Very frequent clinic visits are necessary, initially probably two or three times a week. During such clinic visits, infusions of drugs, fluids and electrolytes, and transfusion of blood products may be needed. At home, you still will take many medications.
Among these are cyclosporine, antibiotics, magnesium, and vitamins. If you have additional questions or concerns, we encourage you to discuss them with your IBMT physician, the clinic nurses, or the transplant coordinator.