Preparing For Stem Cell Transplant
A patient must undergo several pre-transplant procedures prior to receiving a cord blood or bone marrow transplant. Following a general health evaluation, including testing procedures and a medical history assessment, a patient must undergo a preparative regimen or conditioning regimen before receiving a stem cell transplant. Some of these preparations, such as chemotherapy or radiation therapy, can be strenuous. Current stem cell research is looking to reduce and address these more strenuous procedures associated with stem cell or cord blood transplants.
Health Evaluation
A health evaluation of a patient looking to receive a stem cell transplant generally involves the following assessment procedures performed by a doctor:
- Evaluating the body’s overall health including testing organs such as the heart, lungs, liver and kidneys
- Checking for infections that should be treated prior to a stem cell transplant
- Evaluating the status of the disease as active or in remission
- Assessing disease responses to previous treatment
- Checking for other health complications that may affect stem cell transplants
Your health evaluation prior to a stem cell transplant will generally involve physical exams, a review of your health history, and any other testing procedures required. These can include heart tests by an electrocardiogram (EKG) to check heart rhythms, or a multiple gated acquisition scan (MUGA scan) to check how well the heart is pumping. For patients being treated for lymphoma, a positron emission tomography (PET) scan or gallium scan may be used to determine how active the disease is.
An intravenous catheter may be surgically inserted into a vein in the chest and run upwards to the neck. This catheter will be used during preparative chemotherapy, for stem cell infusion, to perform any necessary blood transfusions and even for providing nutrition before and after stem cell transplant.
The Stem Cell Preparative Regimen
A cord blood or bone marrow stem cell transplant will involve a preparative regimen that includes high doses of chemotherapy and in some cases, radiation therapy. The combination of both therapy treatments is known as Total Body Irradiation (TBI), and is commonly used prior to stem cell transplants for the treatment of leukemia, lymphoma or myeloma.
This high-dose therapy treatment is used to destroy any diseased cells in the body as well as blood-forming blood cells in the bone marrow to make room for new stem cells during transplant. The chemotherapy preparative regimen also works to destroy the immune system so as to prevent the patient’s body from attacking newly-transplanted stem cells, also known as GVHD.
Conditioning stem cell therapy can last from four to ten days. The type of conditioning process that a patient will undergo depends on the individual’s overall health, the type of disease being treated by stem cells, and the type of stem cell transplant procedure that will be performed. This may include administering certain drugs to help prevent GVHD.
Stem Cell Conditioning Side Effects
Regardless of the type of conditioning regimen an individual will receive, a stem cell preparative regimen will most likely be accompanied by certain short-term side effects such as:
- Nausea
- Vomiting
- Diarrhea
- Lack of appetite
- Mouth sores
- Hair loss
- Fatigue
- Bleeding
- Skin Rashes
These side effects will generally begin to heal once your white blood cell count begins to increase. However, your doctor or stem cell transplant team can help treat and relieve discomfort upon request.
Some of the more serious yet less common side effects of a stem cell preparatory regimen can include the development of veno-occlusive disease (VOD) of the liver (swelling of the blood vessels), lung damage and damage to the heart muscle, also known as cardiomyopathy. Other rare and long-term side effects of stem cell conditioning can include cataracts, increased risk of organ failure, premature menopause, infertility, and development of secondary cancer, and in some cases can be fatal.
Preparing For Transplant
A cord blood or bone marrow stem cell transplant can be an emotional process. It may be a good idea to make adequate arrangements regarding any responsibilities you may have such as managing a household during your recovery.
You may wish to ensure that you receive emotional support during the entire transplant procedure prior to a stem cell transplant. Talk to your family or friends, and be sure to let any children know what to expect during and after your treatment. You may also wish to speak to a social worker or patients who have already undergone transplants for additional support.
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