Slideshow:
Stem Cell
Transplants for Blood Cancers (webMD )
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What are Stem Cell Transplants?
Bone marrow and
peripheral blood stem cell transplants are ways to treat blood cancers like
leukemia, multiple myeloma, and non-Hodgkin's lymphoma. They help restore the
body’s ability to make blood cells after high-dose chemotherapy or radiation.
As many as 50,000 new transplants are done each year.
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Why Are Stem Cell Transplants Needed?
The high-dose
chemotherapy or radiation used to kill blood cancer cells also kills healthy
bone marrow. Stem cell transplants help restore the bone marrow’s ability
to produce blood cells. In some cases, therapy followed by stem cell
replacement cures the cancer.
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Transplants Often "Plan B"
Blood cancer treatment
usually starts with chemotherapy, either alone or with other drugs and
treatments. Experts often disagree about which treatments to use. Stem cell
transplants are expensive, risky, and usually recommended when chemotherapy
fails. However, some cancer centers are trying stem cell transplants as a first
treatment.
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Where do Stem Cells Come From?
Stem cells can come from
several places. Bone marrow transplants replace diseased marrow with
cancer-free marrow. Peripheral stem cell transplants use stem cells collected
from the bloodstream. Transplants can involve the patient’s own cells
(autologous) or cells from a donor (allogeneic).
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What About Cord Blood?
Stem cells also can come
from newborn umbilical cord blood. Some families bank cord blood for future use
by that child or a sibling. Families can donate cord blood for public use.
Donated cord blood has become a good choice for patients who can't find a close
match in their own families.
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Finding a Match
Some patients can donate
their own stem cells. Others must depend on donations from relatives or
strangers. Finding a close match is important. There can be problems if the new
cells attack the patient’s cells or the patient’s immune system attacks the donor
cells. In North America, Caucasians have a good chance of finding a non-related
donor, but the odds drop for African-Americans and Asians because fewer people
in those groups have become donors.
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Harvesting Stem Cells
Collecting bone marrow
requires placing the donor under anesthesia then using a strong needle to draw
marrow from the hip bone. This takes 1-2 hours in an operating room. For
several days before donating peripheral blood stem cells, donors take special
drug shots to boost stem cell levels in the bloodstream. Then the donor is
connected to a machine that filters the stem cells from the donor’s blood and
returns the rest.
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"Mini" Transplants an Option
There's a newer option
for older and sicker people who may not be able to handle a traditional stem
cell transplant. Mini stem cell transplants, also called reduced-intensity
conditioning, can kill some cancer cells. Yet they subdue the immune system enough
to let donor stem cells take hold. This requires less intense radiation and
chemotherapy but may not work as well at stopping the cancer.
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Complex Set-Up, Simple Procedure
Getting ready for a stem
cell transplant can be hard -- with many medical tests, trying to find a
matching donor, and enduring pre-transplant chemotherapy and radiation. But the
actual transplant is surprisingly simple. Doctors inject the cells into the
bloodstream through an IV while the patient is awake. This takes 1 to 5
hours.
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Waiting for Stem Cells to "Take"
After the transplant,
patients spend two to six weeks in the hospital waiting for the new stem cells
to begin making blood cells. During this time, blood cell counts run low.
Patients are closely watched and may get doses of anti-bacterial, antifungal, and
antiviral drugs to prevent life-threatening infections.
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Recovering from a Stem Cell Transplant
After leaving the
hospital, transplant patients may face months of daily or weekly exams. They
may get many tests, including blood tests, chest X-rays, and bone marrow tests.
During this rehab period, they may have frequent blood transfusions and take antibiotics.
They may have regular medical visits for as long as a year, until the immune
system works well.
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Some Donors Also Need Recovery Time
Bone marrow donation is
also a major medical procedure. Donors usually face a few days of soreness in
their hips. It takes 4 to 6 weeks for their bodies to replace the donated
marrow cells. In rare cases, marrow donors can suffer serious infections or anesthesia
complications. Peripheral stem cell donors may face blood clots,
catheter-related problems, and side effects from drugs given to boost
peripheral stem cell numbers.
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Years of Follow-Up Care
Transplants can save
lives. However, many survivors face challenges years later. Problems often are
related to the process leading up to the transplant or drugs used during the
transplant. These include organ damage, hormone changes, infertility,
neurological effects, and other cancers. Research continues on ways to reduce
these risks and improve quality of life for blood cancer survivors.
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