What you need to know about:

Stem Cell or Bone Marrow Transplantation

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Recovery Period:
2 to 6 weeks
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Overview of

Stem Cell or Bone Marrow Transplantation

in Thailand

Stem cell transplantation, also known as bone marrow transplantation, is used to treat blood diseases such as aplastic anemia, bone marrow failure, and blood cancers, as well as to restore blood-forming cells in the body.  

TYPES OFSTEM CELL TRANSPLANTATION

Autologous stem cell transplantation Allogenic stem cell transplantation from the following sources: 100% Human Leukocyte Antigen (HLA) matching (match-related donor) Donor with 1 to 3 points HLA mismatch (mismatch donor) Unrelated donor with 100% HLA matching (match-unrelated donor) Donor who is the recipient’s sibling, parent or child with 50% HLA matching (haploidentical donor)  

SOURCES OF STEM CELLS

Stem cells are collected from the following sources: Bone marrow Bloodstream Placenta/cord blood  

DISEASES OR CONDITIONS WHICH CAN BE TREATED BY STEM CELL TRANSPLANTATION

Autologous stem cell transplantation is used to treat the following diseases: Multiple myeloma – cancer of plasma cells Lymphoma Leukemia Severe autoimmune diseases which cannot be controlled with medication Allogenic stem cell transplantation is used to treat the following diseases: Lymphoma Leukemia Aplastic anemia Paroxysmal Nocturnal Hemoglobinuria (PNH) Severe Combined Immune Deficiency (SCID) Wiskott-Aldrich syndrome, which is an inherited immune system disorder Pure Red Cell Aplasia  Amegakaryocytosis/Congenital Thrombocytopenia Thalassemia Sickle Cell Anemia Inherited Metabolic Disorders Myelodysplastic Syndrome which is a disorder of blood cell production in the bone marrow

Goals of

Stem Cell or Bone Marrow Transplantation

A stem cell or bone marrow transplant may be used to:  -Safely allow treatment of your condition with high doses of chemotherapy or radiation by replacing or rescuing the bone marrow damaged by treatment -Replace diseased or damaged marrow with new stem cells -Provide new stem cells, which can help kill cancer cells directly  Bone marrow transplants can benefit people with a variety of both cancerous (malignant) and noncancerous (benign) diseases, including:  Acute leukemia Adrenoleukodystrophy Aplastic anemia Bone marrow failure syndromes Chronic leukemia Hemoglobinopathies Hodgkin's lymphoma Immune deficiencies Inborn errors of metabolism Multiple myeloma Myelodysplastic syndromes Neuroblastoma Non-Hodgkin's lymphoma Plasma cell disorders POEMS syndrome Primary amyloidosis

Price of

Stem Cell or Bone Marrow Transplantation

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Pros and cons of

Stem Cell or Bone Marrow Transplantation

Pros

Autologous Stem cell transplants [your own stem cells]  

Pros:  -Less risk of rejection or graft-versus-host disease, in which the new donor cells think your cells are foreign and attack them. -Quicker engraftment.  -Fewer side effects.

Allogenic Stem cell transplants [using a donor's stem cells - either a family relative or volunteer donor]  

Pros:  -The transplanted stem cells are cancer-free. Because the transplant creates a new immune system, the cancer-killing effect continues after the transplant.

Cons

Autologous Stem cell transplants [your own stem cells]  
Cons:  -Some cancer cells may still remain; cancer-killing effect ends after you have chemotherapy or radiation.

Allogenic Stem cell transplants [using a donor's stem cells - either a family relative or volunteer donor]
Cons:  -Your body may see the donor stem cells as foreign and reject or react against them.  -Slower engraftment.  -More side effects

How it works:

Stem Cell or Bone Marrow Transplantation

You will first need to have stem cells collected before your transplant. There are two types of transplants: 1. Collecting stem cells for autologous transplant If a transplant using your own stem cells (autologous transplant) is planned, you'll undergo a procedure called apheresis to collect blood stem cells. Before apheresis, you'll receive daily injections of growth factor to increase stem cell production and move stem cells into your circulating blood so that they can be collected. During apheresis, blood is drawn from a vein and circulated through a machine. The machine separates your blood into different parts, including stem cells. These stem cells are collected and frozen for future use in the transplant. The remaining blood is returned to your body. During Treatment: The patient will be admitted to a special sterile room to reduce the risk of infection. The patient will then receive chemotherapy and/or radiation to kill abnormal cells (normal cells can also be damaged by the treatment). After the chemotherapy and/or radiation, the peripheral stem cell transplantation will be administered. It also takes time for the bone marrow or stem cells to work properly. The patient will need to be under close observation and take precautionary measures so as to prevent possible complications. 2.Collecting stem cells for allogeneic transplant If you're having a transplant using stem cells from a donor (allogeneic transplant), you will need a donor. Once a donor is found, stem cells are gathered from that person for the transplant. Stem cells can come from your donor's blood or bone marrow. Your transplant team decides which is better for you based on your situation. Another type of allogeneic transplant uses stem cells from the blood of umbilical cords (cord blood transplant). Mothers can choose to donate umbilical cords after their babies' births. The blood from these cords is frozen and stored in a cord blood bank until needed for a bone marrow transplant. After you complete your pretransplant tests and procedures, you begin a process known as conditioning. During conditioning, you'll undergo chemotherapy and possibly radiation to: -Destroy cancer cells if you are being treated for a malignancy -Suppress your immune system -Prepare your bone marrow for the new stem cells The type of conditioning process you receive depends on a number of factors, including your disease, overall health and the type of transplant planned. You may have both chemotherapy and radiation or just one of these treatments as part of your conditioning treatment. Your bone marrow transplant occurs after you complete the conditioning process. On the day of your transplant, stem cells are infused into your body through your central line. The transplant infusion is painless. You'll be awake during the procedure.

Preparation before

Stem Cell or Bone Marrow Transplantation

Pre - treatment

Pretransplant tests and procedures You'll undergo a series of tests and procedures to assess your general health and the status of your condition, and to ensure that you're physically prepared for the transplant. The evaluation may take several days or more. In addition, a surgeon or radiologist will implant a long thin tube (intravenous catheter) into a large vein in your chest or neck. The catheter, often called a central line, usually remains in place for the duration of your treatment. Your transplant team will use the central line to infuse the transplanted stem cells, medications and blood products into your body. Collecting stem cells for autologous transplant If a transplant using your own stem cells (autologous transplant) is planned, you'll undergo a procedure called apheresis (af-uh-REE-sis) to collect blood stem cells. Before apheresis, you'll receive daily injections of growth factor to increase stem cell production and move stem cells into your circulating blood so that they can be collected. During apheresis, blood is drawn from a vein and circulated through a machine. The machine separates your blood into different parts, including stem cells. These stem cells are collected and frozen for future use in the transplant. The remaining blood is returned to your body. Collecting stem cells for allogeneic transplant If you're having a transplant using stem cells from a donor (allogeneic transplant), you will need a donor. Once a donor is found, stem cells are gathered from that person for the transplant. Stem cells can come from your donor's blood or bone marrow. Your transplant team decides which is better for you based on your situation. Another type of allogeneic transplant uses stem cells from the blood of umbilical cords (cord blood transplant). Mothers can choose to donate umbilical cords after their babies' births. The blood from these cords is frozen and stored in a cord blood bank until needed for a bone marrow transplant.

Recovery after

Stem Cell or Bone Marrow Transplantation

Post - treatment

When the new stem cells enter your body, they travel through your blood to your bone marrow. In time, they multiply and begin to make new, healthy blood cells. This is called engraftment. It usually takes several weeks before the number of blood cells in your body starts to return to normal. In some people, it may take longer. In the days and weeks after your bone marrow transplant, you'll have blood tests and other tests to monitor your condition. You may need medicine to manage complications, such as nausea and diarrhea. After your bone marrow transplant, you'll remain under close medical care. If you're experiencing infections or other complications, you may need to stay in the hospital for several days or sometimes longer. Depending on the type of transplant and the risk of complications, you'll need to remain near the hospital for several weeks to months to allow close monitoring. You may also need periodic transfusions of red blood cells and platelets until your bone marrow begins producing enough of those cells on its own. You may be at greater risk of infections or other complications for months to years after your transplant. You'll have periodic lifelong follow-up appointments with your doctor to monitor for late complications.

Risks & side effects

1. Graft versus host disease [GVHD] If you receive a transplant that uses stem cells from a donor (allogeneic transplant), you may be at risk of developing GVHD. This condition occurs when the donor stem cells that make up your new immune system see your body's tissues and organs as something foreign and attack them. GVHD may happen at any time after your transplant. Many people who have an allogeneic transplant get GVHD at some point. The risk of GVHD is a bit greater if the stem cells come from an unrelated donor, but it can happen to anyone who gets a bone marrow transplant from a donor. There are two kinds of GVHD: acute and chronic. Acute GVHD usually happens earlier, during the first months after your transplant. It typically affects your skin, digestive tract or liver. Chronic GVHD typically develops later and can affect many organs. 2. Infection from low immunity during transplantation process Chemotherapy and some other treatments weaken your body’s immune system. This is especially true of treatment given for a bone marrow/stem cell transplant, because the bone marrow is part of the immune system. When your immune system is weakened, your body cannot protect itself as well against germs. Most of these germs already live in your body. When your immune system is strong, these germs do not make you sick. But after a transplant, they can cause an infection. Fortunately, most of these infections are fairly easy to treat with antibiotics. After about 2 weeks from your transplant day, the immune system cells called neutrophils will begin recovering. Neutrophils keep some common germs from making you sick. Your risk for infections will be highest in the first few weeks after transplant. However, your immune system may need a long time to recover after a transplant. You may need to take medications to fight infection for a year or more after your bone marrow/stem cell transplant. Your health care team will talk with you about ways to reduce your risk of infections by taking precautions during your recovery. Learn more about infections as a side effect of cancer treatment.

FAQs:

Stem Cell or Bone Marrow Transplantation

What is recovering from a bone marrow transplant like?

Recovery from a bone marrow/stem cell transplant takes a long time. Recovery often has stages, starting with intensive medical monitoring after your transplant day. As your long-term recovery moves forward, you will eventually transition to a schedule of regular medical checkups over the coming months and years.  During the initial recovery period, it's important to watch for signs of infection. The intensive chemotherapy treatments that you get before your transplant also damage your immune system. This is so your body can accept the transplant without attacking the stem cells. It takes time for your immune system to work again after the transplant. This means that you are more likely to get an infection right after your transplant.  To reduce your risk of infection, you will get antibiotics and other medications. If you had an ALLO transplant, your medications will include drugs to prevent and/or manage GVHD. Follow your health care team's recommendations for how to prevent infection immediately after your transplant.  It is common to develop an infection after a bone marrow transplant, even if you are very careful. Your doctor will monitor you closely for signs of an infection. You will have regular blood tests and other tests to see how your body and immune system are responding to the donor cells. You may also get blood transfusions through your catheter.

How will I be able to know that my transplant worked?

Your blood counts are back to safe levels - A blood count measures the levels of red blood cells, white blood cells, and platelets in your blood. At first, the transplant makes these numbers very low for 1 to 2 weeks. This affects your immune system and puts you at a risk for infections, bleeding, and tiredness. Your health care team will lower these risks by giving your blood and platelet transfusions. You will also take antibiotics to help prevent infections. When the new stem cells multiply, they make more blood cells. Then your blood counts will go back up. This is one way to know if a transplant was a success.  Your cancer is controlled - Curing your cancer is often the goal of a bone marrow/stem cell transplant. A cure may be possible for certain cancers, such as some types of leukemia and lymphoma. For other diseases, remission of the cancer is the best possible result. Remission is having no signs or symptoms of cancer. As discussed above, you need to see your doctor and have tests regularly after a transplant. This is to watch for any signs of cancer or complications from the transplant, as well as to provide care for any side effects you experience. This follow-up care is an important part of your recovery.

Will I feel pain during the procedure?

You may feel pain or discomfort during the stem cell infusion. Pain can also be a sign of a complication. Tell your doctor about any pain you feel during or after the infusion and throughout your recovery.

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