Autologous Blood Stem Cell Transplant Program - Introduction
The goal of the transplant team is to provide effective, respectful and individualized care. The staff recognizes that you are here with hopes of curing your disease or of putting it into remission, and we will work with you to help you achieve your goal.
Autologous blood stem cell transplant (ABSCT) is a treatment choice for certain cancers and although there are other treatment options this is the 'gold standard' for the treatment of Primary AL Amyloidosis. The success of this treatment depends on your diagnosis and stage of disease.
About the Transplant Program
Autologous blood stem cell transplant is a treatment choice which includes the use of high-dose chemotherapy (Malphalan) followed by an infusion of stem cells taken from the blood. This treatment is used extensively throughout the world.
Autologous transplants were first done at Tom Baker Cancer Centre (TBCC) in 1980, using stem cells from the patient’s own bone marrow (Autologous marrow transplant). By 1992 the treatment process evolved into one using stem cells taken from the patient’s blood.
The move from autologous marrow transplant to autologous blood stem cell transplant has resulted in faster recovery and decreased hospitalization time. Presently we are treating about 60-70 patients a year using the ABSCT treatment.
During the transplant treatment, care is provided at both Tom Baker Cancer Centre and Foothills Medical Centre (FMC). Currently this program primarily treats patients in Southern Alberta, as well as a few patients from British Columbia and Saskatchewan. An autologous blood stem cell transplant program also; exists at the Cross Cancer Institute in Edmonton.
Basics of Autologous Blood Stem Cell Transplant
Autologous blood stem cell transplant (ABSCT) is a way of giving very high doses of chemotherapy safely, using your blood stem cells as a "rescue". Your stem cells are collected before high dose chemotherapy is given. The high dose chemotherapy treats the disease, but it also damages the bone marrow. After this treatment is given, your stem cells are infused and they regrow the bone marrow.
What is Bone Marrow?
Bone marrow is the organ in the body which makes blood cells. It is a spongy tissue found in the cavities of many bones. An ample amount is found in the bones of the hips, as well as in some other bones of the body.
What are Stem Cells?
Blood Stem cells are the most basic or immature cells and are often called “parent” cells of the blood system. These cells normally live in the bone marrow.
All blood stem cells contain basic genetic information which allows them to mature into one of three cells that form the blood. These are:
· White blood cells (WBC) - These cells help the body to fight infection.
· Red blood cells (RBC) - They contain hemoglobin, which carries oxygen to the body tissues.
· Platelets (Pits) - These are the cells that help to clot blood and control bleeding.
Chemotherapy in Autologous Blood Stem Cell Transplant
Chemotherapy and radiotherapy have been used for many years to destroy cancer cells. While radiotherapy kills tumor cells in a localized area, chemotherapy reaches nearly all the body tissues. If you have had chemotherapy, you are aware that these drugs also affect normal tissue cells that are rapidly growing, causing side effects such as hair loss, sore mouth, nausea, vomiting, diarrhea and low blood counts.
With ABSCT, higher doses of chemotherapy are used. This intensive therapy offers a better chance of getting a cure or remission of disease. However, with such high drug doses, the side effects can be more severe.
The critical side effect of this treatment is serious damage to the bone marrow. The bone marrow must be restored or "rescued" with an infusion of stem cells. Once your stem cells are returned to you, they begin to regrow in the marrow spaces. This takes about two weeks.
Autologous Blood Stem Cell Transplant Procedure
Mobilization of Stem Cells
Because blood stem cells are normally found only in the marrow, a special mobilization process is used to increase the number of stem cells produced in the marrow, and move them into the blood stream.
This process includes:
· Chemotherapy which is called mobilization chemotherapy and which differs from the high dose chemotherapy used for your transplant. After receiving mobilization chemotherapy, the bone marrow responds by increasing the production of stem cells. (not being used in my case)
· G-CSF injections. G-CSF is a substance found normally in the body that stimulates the growth of stem cells. When a growth factor such as G-CSF is injected in addition to chemotherapy, it causes the bone marrow to increase stem cell production. Filgrastim, a synthetic version of this substance, will be used.
Collection of Stem Cells (Apheresis)
Your stem cells will be collected in the Foothills Medical Centre, in a special area called the apheresis ward.
Prior to apheresis, you will have a Central Venous Catheter (CVC) inserted which will be used for this procedure.
The length of the apheresis procedure varies between four to six hours depending on the number of stem cells needed. Occasionally a second day, or more commonly a second cycle, of apheresis may be necessary.
Once collection is complete, the cells are frozen with a preservative and stored until they are needed.
After collection of your stem cells you will either:
· require further testing or treatment with chemotherapy, radiotherapy or surgery. (Some patients may need a time for recovery before starting the transplant treatment), or
· begin high dose chemotherapy for transplantation.
Transplantation
Autologous Blood Stem Cell Transplant usually requires a three week hospital stay. Once the chemotherapy has cleared from your body, usually within one to three days, your stem cells are thawed and given back to you through your CVC.
It takes about two weeks for the stem cells to begin to restore your marrow. This regrowing of marrow is called engraftment.
During this time you will experience the side effects of chemotherapy, and will need close monitoring for:
* infection
* fatigue
* mouth sores
* need for blood products
* nausea & vomiting
* nutrition and fluid balance
Recovery
After discharge from hospital, you will be monitored closely for a few weeks in the outpatient Bone Marrow Transplant (BMT) clinic at Tom Baker Cancer Centre (TBCC)
During this time it is important that you drink adequate fluids every day (about 8 glasses) and eat reasonably well. The dietitian at TBCC is available to see you if you are having any difficulty eating or drinking.
Impact of Treatment with Blood Stem Cell Transplant
Quality of Life Before and After Transplant
Before transplant you will be spending considerable time at TBCC and FMC attending appointments in preparation for transplant. If you are presently responsible to care for children or elderly family members you will need to ask your family or friends for help with those responsibilities.
After transplant, the quality of your life may be changed for a period of time. Fatigue is very common. It varies from mild to severe and can last for some time. Energy levels vary as well. Some patients have very limited energy, while some have much more. This often depends on the type of conditioning treatment used to prepare for transplant. For many people, daily living activities such as eating or bathing, are the only activities possible for several days.
· Sleep patterns can be affected. Sleep may become interrupted and one may experience unpleasant dreams.
· Depression may occur.
· Depending on your energy level, you may need to adjust your priorities. This change in lifestyle will vary from patient to patient.
· If you are working, you will need to take time off from your job. It is usual to be off work for approximately six months, though some patients return to part-time work about two to three months after transplant.
The Need for a Committed Helper(s)
Having one or more committed helpers or primary caregivers is an important consideration. He or she will need to support you while you go through the stages of transplant.
There are several responsibilities that a caregiver can assume:
· provide emotional support
· assist with transportation
· make or remind you of appointments
· provide physical care such as give medications, help with care of the central line, identify and report changes in your health.
· care for your dependents (either children or parents)
· household duties
How You Can Help
If you are able, you are encouraged to help with your preparation for and recovery from stem cell transplant. Here are some suggestions of ways you may help:
· Consult the team psychologist when you need assistance that he/she can provide
· Talk openly with your family and close friends so that they might be a source of support for you. Try to avoid isolation.
· Allow family members to help.
· Let your caregiver become involved and assume the responsibilities as outlined previously.
· Delegate people to do housework, yard work, run errands and help prepare meals. Meals can be prepared ahead and frozen.
· Consider taking "time out" with your significant other to help your relationship remain strong. This may be an evening or a weekend away together.
· Consider the "Kids can Cope" program offered by the TBCC, to help your children deal with the stress of your illness.
· Ask friends or family to come and stay with you after transplant.