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Bone Marrow Transplantation at the University of Colorado Cancer Center

Acute leukemia, lymphoma and myeloma have remission and cure rates that increase in relationship to the amount of chemotherapy given to a patient.

Intensive treatment, though, can severely damage the bone marrow. UCH specialists use stem cell transplantation to restore normal blood production after administering large doses of chemotherapy or radiation therapy.

An integrated program

Unlike most cancer centers, our blood and marrow transplant program is integrated into our blood cancer department, so patients are able to go through the entire treatment program with the same team of experts and coordinated care they’ve come to know and trust.

The University of Colorado Cancer Center also uses specially designed impatient and outpatient facilities to protect transplant patients with weakened immune systems. Our blood and marrow transplantation program meets rigorous industry and governmental standards. Here you will also get a personalized care plan backed by the latest proven research.

To learn more about the blood and marrow transplant program at the University of Colorado Cancer Center, call us today at (720) 848-0300.

What are Blood & Marrow Transplants?

Transplant Types

Autologous Transplantation (also known as Autologous Infusion)

Illustration: Center for Reproductive Sciences

Stem cells are obtained from your own bone marrow and infused back into you. This process requires that you have enough healthy stem cells in marrow or blood despite your disease. The key is to achieve a complete remission (no evidence of disease at the genetic level) in order to collect and harvest cancer-free stem cells.

  • Autologous transplantation does not carry the risk of your body’s immune system rejecting the stem cells because they come from you.
  • This method is now used to restore blood cell production for cancers other than leukemia, lymphoma and myeloma (for example, germ cell tumors).
  • These transplants often can be done on an outpatient basis and generally have a shorter recovery period than allogeneic transplantation.

Allogeneic Transplantation

A transplant between two people in which the donor’s tissue type closely matches the recipients. Your sibling is most likely to match you. Doctors can test compatibility through lab tests.

Allogeneic stem cell transplantation can be used to successfully cure patients who:

  • Are at high risk of relapse
  • Do not respond fully to treatment
  • Relapse after prior successful treatment

There are two types of donors: related (usually a sibling) or unrelated. Unrelated donors are usually found within very large pools of volunteers.

Allogeneic transplants have the risk of:

  • Immune rejection of donated stem cells by recipient (host-versus-graft effect)
  • Immune reaction by the donor’s cells against the tissues of the recipient (graft-versus-host disease)

At the same time, allogeneic transplants have an advantage because the donor blood cells help fight the cancer (graft versus tumor effect). New techniques are being used to exploit the graft versus tumor effect, and we are at the forefront of research in this area.

Nonmyeloblative Transplantation (Mini Transplants)

This type of allogeneic transplant uses low— rather than very high—doses of either radiation or chemotherapy to get you ready for transplant. The goal is to create a “niche” in your marrow to accommodate the donor stem cells while causing minimal toxic reactions.

Then, after “engraftment”, the donor stem cells will attack your blood cancer cells. It may be an option for older patients in their 60s and 70s who cannot tolerate higher treatment doses. A number of studies have shown these transplants to be safe and effective, particularly in older patients.

 

Transplant Process

Before the Transplant

The decision to use this approach takes into account:

  • Your age, general health and medical condition
  • Type of cancer that you have
  • The availability of a tissue-matched donor, for allogeneic transplants

Obtaining Donor Stem Cells

You and your siblings are tested to determine your tissue type or human leukocyte antigen (HLA) type.

  • You have about a one in four chance of having the same HLA type as your sibling.
  • This compatibility is important because if the immune cells of you and your donor recognize one another as foreign, they will attack each other.

Once a matched and healthy donor is found, he or she undergoes intensive testing to make sure the donor is fit and healthy and clear of infectious diseases. The donor is then treated with a drug that draws stem cells out of the bone marrow and into the bloodstream. The stem cells are then recovered from the blood through a process called leukapheresis.

Leukapheresis – uses a device to remove necessary cells from the blood while returning the unused parts (red cells and plasma) to the donor.

Conditioning

If you are an allogeneic transplant patient, you will receive conditioning therapy with chemotherapy drugs and total body irradiation the week before the transplant. We do this:

  • To reduce a cancer recurrence by intensively treating the remaining, minimal, cancer cells
  • To limit the chance of graft versus host disease by inactivating your immune system

Infusion of Stem Cells

Donor stem cells are collected in a plastic blood transfusion bag. The cells are infused through one of your veins, similar to a blood transfusion. The process usually lasts less than an hour.

You will be monitored for signs of fevers, chills, hives, a fall in blood pressure or shortness of breath. You may not experience side effects from the infusion. But if you do, they generally can be treated and the infusion completed.

 


 

After Transplant

The effects of the intensive conditioning therapy and decrease in bone marrow function begin to have their effects by the second or third day after the transplant.

  • Because your immune system has been suppressed, your ability to fight infection is very low
  • You will be kept on a special, HEPA-filtered, protective hospital unit that limits your exposure to any type of infection
  • You may be isolated on this unit for approximately a month as the donor stem cells begin forming enough blood and immune cells to restore your immune system
  • You also may receive red cell and platelet transfusions
  • You will be carefully monitored to make sure your organs are functioning normally

Like most transplant patients, you may need nutritional support and, for allogeneic transplant patients, special drugs to treat graft-versus-host disease.

You probably will be able to leave the hospital within three (for autologous) to five weeks (for allogeneic) after your transplant. You will be discharged when:

  • Your bone marrow is producing a sufficient number of healthy red cells, white cells and platelets
  • You have no severe complications
  • You have a sense of well being. Any mouth sores and diarrhea lessen or are gone
  • You have a good appetite
  • You have no fever or vomiting

 

Life After Transplant

After leaving the hospital, you will recover at home. You will receive home visits from your home care team and visit the outpatient clinic for follow-up care every week for about three months. After several months, if all is going well, your venous catheter will be removed, and you’ll have fewer follow-up visits.

If you received an allogeneic transplant, it will take at least six to 12 months to recover normal blood cell levels and immune cell function. During that time, you will need to consider these issues:

  • Avoid contact with crowds and with children who have had recent immunizations with live viruses.
  • You may need to be re-immunized for certain diseases because your immunity from previous vaccinations may be reduced.
  • The radiation you received may lead to cataracts in your eyes, sterility in men and premature menopause in women. Women may need estrogen and progesterone replacement therapy.
  • Radiation may decrease thyroid function, and you may require a thyroid hormone.
Source: Leukemia & Lymphoma Society

 

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