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Ask the Expert: The type of cancer, patient’s age, general health, availability of donors and other factors determine the type of transplant
Is one person’s bone marrow literally transplanted into another during a bone marrow transplant?
Hematopoietic stem cell transplants (commonly referred to as bone marrow transplants) are typically used to treat blood cancers such as leukemia, lymphoma and multiple myeloma.
Hematopoietic stem cell transplant encompasses peripheral blood stem cell transplant, bone marrow transplant and alternative donor transplant as well. In the majority of cases, the source of the stem cell to complete the transplant is taken from the bloodstream of the patient or a donor (peripheral blood stem cell transplant).
In a smaller number of cases, the patient may receive stem cells from umbilical cord blood or stem cells from a donor’s actual bone marrow.
If the stem cells are taken from the patient, it is called an autologous transplant. If the stem cells are from a donor, it is an allogeneic transplant. Both types of transplants use hematopoietic stem cells that can have the capacity for self-renewal and the ability to form all types of blood cells including red blood cells, white blood cells and platelets.
The stem cells are transfused into the patient’s bloodstream, where they migrate to the bone marrow and grow into healthy new blood cells and therefore repopulate the bone marrow.
In autologous transplants, the dose of chemotherapy is what provides the benefit of disease control/cure. It is more commonly considered as a therapeutic modality for multiple myeloma, where it offers disease control and for recurrent Non-Hodgkin Lymphoma or Hodgkin’s disease where it has the potential for cure.
In allogeneic transplants, the dose of chemotherapy provide benefit but also the interaction between the donor and recipient cells allow a protective response called graft versus tumor effect. It should be noted that each type of transplant is associated with its own risks and benefits.
If an allogeneic transplant is to be performed, a donor search is initiated. Donors have to be closely genetically matched. The donor search usually begins with full blood siblings, who have about a 25 percent chance of being a match (matched-related donor).
For those individuals without a sibling match (70 percent of patients) the search is entered into a registry of donors through the National Marrow Donor Program, where a potential donor is identified (matched-unrelated donor). For those without a full match alternative donor transplants such as umbilical cord or haploidentical transplants (parent or children) may be considered.
The patient’s type of cancer, age, general health, availability of donors, and other factors determine whether an autologous or allogeneic transplant is performed.
The Cancer Transplant Institute at the Virginia G. Piper Cancer Center at HonorHealth has been recognized by the NMDP. It is also one of only 106 U.S. bone marrow transplant centers accredited by the Foundation for the Accreditation of Cellular Therapy for both autologous and allogeneic transplants.
Veena Fauble, MD, is a physician at the Cancer Transplant Institute at the Virginia G. Piper Cancer Center at HonorHealth. For more information about bone marrow transplants available at HonorHealth, please contact an oncology nurse navigator at 480-323-1339 or HonorHealth/cancer.
After stem cell transplants for blood cancers, patients — with help from their caregivers — must be careful to avoid infections.
Nikki Mann knows first-hand that it takes patience, diligence and teamwork to help a loved one recover from a stem-cell transplant following a blood cancer diagnosis.
Her husband, Bill Mann, successfully underwent a stem-cell transplant in 2004, four years after he was diagnosed with multiple myeloma at the age of 45.
Although the transplant was uncharted territory for the Manns, Nikki’s role as caregiver had already been cemented through their initial years of his cancer saga. This time, they both had to be mindful of the heightened risk for infection in the ensuing days and weeks, because a stem-cell recipient’s immune system is weakened for a period of time after a transplant.
From an infection standpoint, the main risks are viral and fungal infections, but some bacterial infection risk is present too, particularly for patients whose treatment regimen relies on intravenous catheters that stay implanted for months at a time, says medical oncologist Ravi Vij, a specialist in bone marrow/stem cell transplants at the Siteman Cancer Center at the Washington University School of Medicine in St. Louis, Mo.
Hello there, before I get things going I think we should all stop and appreciate the pun that forms the title of this blog. I am saying ‘hello’ because I have been absent from my blog of late and I am saying ‘Allo’ because I am writing to tell you all about the allogenic transplant […]
I am often being told that My Myeloma is not all my own. It would be correct to say that my illness is not all about me, the people around me have suffered effects of the illness just as I have; they’ve metaphorically and actually held my hand, they have lost a drinking mate, they […]
My requirements on Monday were not restricted to signing my life away. Some people work out before a marathon, my pre marathon training is something else all together. In order for Transplant Number 2 to go ahead, I had to have a collection of tests done, the purpose of which, I think, was really for […]
When I eventually wake up today, the first thought I am going to have, after the one we all have first thing in the morning about emptying our bladders, will be ’16 days’. I know I will have this thought because I have had the same sort of numerically decreasing thought every other morning for […]
Stem cell transplants may be more effective than the drug mitoxantrone for people with severe cases of multiple sclerosis (MS), according to a new study published in the February 11, 2015, online issue of Neurology, the medical journal of the American …
Before I cut and paste this story, I must give my own views on this. I’m not convinced that this is safe for the patient.
Although Dom’s transplant was over 5 years ago, it was SO MUCH DIFFERENT…. for the better, I believe.
Firstly, after living in this home for 25 years, there was no way that I’d bring my husband home to 25 years of “stuff”.
Instead, we moved into an apartment a few weeks prior to his procedure. I hired a guy to come in and “sanitize” the apartment. (A fog and a spray).
After the transplant, he was in the hospital for several (?) weeks. Once he returned to our new home, he was not permitted to eat ANY fresh vegetables or fruit. Canned, only…. as long as the cans were washed with warm soapy water and opened up by hand.
It was a couple of months before she allowed him to go out for pizza and a movie….. the movies were matinees, and the meals would be during “off hours”, so as to pretty much have the restaurant to ourselves. (MASK)
His mother was in poor health in her mid-nineties. NOPE. Finally, our doctor allowed him to put on his mask, park in her driveway to allow her to visit her only child.
If we had to do it all over again, we’d choose the same method. He’s worth it. *winking and smiling*
Bringing a major medical treatment home. Patients once spent weeks in the hospital. Now they can get a stem cell transplant and go home. It means tackling a lot of hurdles, but this new idea is offering tremendous relief to patients.
She passes the time with a little knitting … and a visit with her doctor. Then there’s a quick flush of the central line in her chest, placed this past summer before Rebecca Zoltoski began a four-month course of chemotherapy to fight myeloma – cancer of her bone marrow.
Rebecca Zoltoski, stem cell transplant patient: “You do what you have to do.”
But this is not a doctor’s appointment. This is day three of Rebecca’s stem cell transplant. Her doctors are ready to infuse a batch of new cells – her own – with the hope they will grow into healthy bone marrow.
Dr Michael Bishop, University of Chicago Medicine, medical oncologist: “Think of the stem cells as the seeds of the bone marrow. It takes time to start growing and maturing and appearing in the peripheral blood, and that’s about a 10-day process.”
As the cells grow, patients wait. It’s an intense process that typically requires a 21-day stay in the hospital. But Rebecca is an outpatient. And after her daily check in – she’s ready to head out.
Dr Michael Bishop: “We would take her and monitor her blood counts, monitor her kidney and liver functions and make sure she’s doing ok. If everything looks cool, we send her on her merry way with very strict instructions that in that interim, before we would see her the next day, if she developed signs of infection, fever, cough, diarrhea, that she immediately gives us a phone call.”
It’s a new program at University of Chicago Medicine – the outpatient stem cell unit has been up and running for about three weeks.
Rebecca Zoltoski: “This afternoon I hope to get out and get a good walk in so I can try to get some of my energy back because I find that helps me a lot. I wouldn’t really be able to be outside if I were here as an inpatient.”
Dr Michael Bishop: “Knowing you are going home every day, that’s the psychological advantage. They have the comfort of their own home, own bed, foods they are used to and like.”
Rebecca Zoltoski: “I did have some concerns about things that could happen, negative things that could happen.”
And there are risks. Patients undergoing a stem cell transplant have weak immune systems and extremely low blood counts – their ability to fight infection is severely compromised.
Dr Michael Bishop: “Most of the time, 75% of the time the patient is going to be fine. One in four will have to be admitted to the hospital primarily for signs and symptoms of an infection.”
That’s why doctors place constraints on outpatients.
Dr Bishop: “Limited to no crowds, wear a mask, strict hand washing.”
Still, the outpatient process appealed to Rebecca.
Rebecca Zoltoski: “I have an 11-year-old at home, and it’s nice to be able to see her. And it’s nice for her to be able to see me, and know I’m doing ok. That’s been the positive of it.”
Patients who experienced early relapse of their multiple myeloma after undergoing autologous stem cell transplantation had worse overall survival and progression-free survival compared with those patients with a longer time to relapse, according to the results of a study published in Bone Marrow Transplantation.
“We conclude that early relapse after autologous stem cell transplantation appears to be a major prognostic variable in multiple myeloma,” wrote researchers led by Victor H. Jimenez-Zepeda, MD, of Princess Margaret Cancer Centre, Toronto. “Patients with early relapse post-autologous stem cell transplantation should biologically be characterized in prospective studies to better understand the mechanisms of resistance associated with this particular entity.”
According to the study, prior research has identified several factors associated with worse outcomes in the post-transplant realm, including elevated plasma cell labeling index, more than one treatment regimen prior to transplant, failure to achieve a complete response, and loss of complete response within 1 year of transplant.
In this study, Jimenez-Zepeda and colleagues analyzed the effects of early relapse on survival. They evaluated 184 consecutive patients with multiple myeloma who underwent single autologous stem cell transplantation between January 2002 and September 2012 and had novel induction therapy.
Of these patients, 15.3% achieved a complete response and 57.1% achieved a very good partial response at day 100 post-transplant. A smaller percentage of patients with early relapse had a very good partial response or better compared with those without early relapse (38% vs 70%; P = .008) at day 100 post-transplant.
The median progression-free survival for the group analyzed was 25.4 months. The median time to relapse was 17.2 months. Early relapse occurred in 36% of the patients who relapsed and was most common in patients treated with thalidomide induction regimens. According to the researchers, this result suggests that “second-generation immunomodulatory drugs and proteasome inhibitors might be better options to prevent early relapse to occur in the setting of autologous stem cell transplantation.”
Patients with early relapse had a median overall survival of 20 months compared with 93 months for those without early relapse (P = .001). Even among patients with a very good partial response who experienced early relapse, overall survival was significantly shorter than those patients who achieved the same level of response but without early relapse (38.53 months vs 79.3 months; P = .013).
The researchers evaluated the prognostic value of cytogenetic features on outcomes, but found that only a single case in the 27 early relapses had high-risk cytogenetics.
Finally, the researchers examined outcomes adjusted for age, best response to induction therapy, best response at day 100 post-transplant, and other variables, and found that early relapse was a major independent prognostic factor for overall survival in these patients.
“As patients with early relapse exhibited a lower rate of very good partial response or higher, new-generation drugs and strategies such as consolidation or maintenance should be considered especially for those patients where there is a high tumor burden,” the researchers wrote. “Studies on minimal residual disease and a more broad and deep panel of cytogenetics will help identifying some intrinsic biological factors that could be associated with lack of response sustainability.”