Cancer Fighters Thrive is a quarterly print and online magazine bringing readers practical, innovative and inspirational information about cancer treatment and survivorship.
Issue link: http://cancerfightersthrive.epubxp.com/i/259111
44 cancer fighters thrive | spring 2014 cf thrive. com procedure is outlined in more detail be- low, but frst let's look at how hematopoi- etic stem cells are collected. Hematopoietic Stem Cell Collection There are two ways to collect—or har- vest—hematopoietic stem cells. One is through a "bone marrow harvest," which is a procedure that occurs in an operating room while the patient is under general anesthesia. A transplant physician inserts a bone marrow biopsy needle in the mar- row cavity, preferably in the posterior hip bone, and extracts marrow, which con- tains stem cells. This is repeated multiple times. The procedure takes about two hours and may result in minor soreness at the withdrawal site, which can last for a few weeks. The complications are negli- gible. Another, more common method of collecting stem cells is called "peripheral blood stem cell collection." Small num- bers of stem cells circulate normally in the blood. These can be collected through a catheter (similar to those used for donat- ing blood) and are then placed in a device known as an apheresis machine, which spins the blood. The spinning process separates the stem cells from the rest of the blood, which is then returned to the patient's body. This process is performed for several days until enough stem cells have been collected to support treatment with high- dose chemotherapy. Most donors have suffcient stem cells collected within two to four days, following Food and Drug Administration–approved medication to boost stem cell production and mobiliza- tion for collection. The risks to the donor are minimal and generally occur within fve to seven days. Stephen underwent peripheral blood stem cell collection. "It was almost pain- less," he recalls. "I was there for about two and a half days, and they harvested a lot more stem cells than they needed." Once stem cells are collected, a patient is ready to undergo one of the following transplant procedures. Autologous Transplantation "An autologous transplant is really a res- cue procedure," explains David Topolsky, MD, Medical Oncologist at CTCA in Phil- adelphia. "We give the patient high doses of chemo—between 10 and 20 times the dose that you can normally give—over a few days or a week. This hopefully kills the cancer but consequently kills the bone marrow too." A few days after chemotherapy is fn- ished, the stem cell "rescue" is performed. It is a fairly simple procedure. First the stem cells are thawed in a water bath right at the patient's bedside. The water bath is at body temperature, and the stem cells go from solid to liquid in about 30 sec- onds. Next a physician uses a syringe to extract the stem cells from the bag and then inject them into the patient's central catheter, where the stem cells go to work and do their job. "The stem cells get into the bloodstream," explains Dr. Topolsky. "The bone marrow and the blood are in communication with each other, so the stem cells fnd their way to the bone mar- row and reimplant there—sort of like a tomato seed in a freshly fertilized garden. They grow over the next seven to 14 days." Syed Abutalib, MD, Assistant Director of the Stem Cell Transplant and Cell Ther- apy Program at CTCA in Zion, Illinois, explains that the rationale for transplanta- tion is not necessarily cure. "I tell patients, 'This is a procedure we think will help you sustain remission,' " he says. "The autolo- gous transplant will help consolidate the patient's response into a better, prolonged remission in most instances." The average hospital stay for the entire process—from chemotherapy to trans- plant to recovery—is three to four weeks. This includes one to seven days of che- motherapy followed by a 10- to 20-day recovery period. The recovery period is essentially a period of isolation to prevent infection. The side effects of the procedure (re- ally from the high-dose chemotherapy) include nausea, vomiting and mucositis (mouth sores). These side effects are gen- erally manageable with medications and tend to improve around the time the bone marrow is recovering. "The hardest part I went through—be- sides the loneliness and the isolation—was the mouth sores," Stephen recalls. "If it wasn't for my doctors' knowing how to manage it with medication, it would have been unbearable." Stephen said the transplant itself was pretty simple. "I was awake, and they gave me Ativan® [lorazepam] and antinausea medication frst," he explains. "They put the frst syringe in and then you take one or two breaths and all of a sudden you feel burning in your throat, kind of like you breathed in ammonia or vinegar. Then you get a weird taste, like a mix between garlic and battery acid. They had warned me this would happen. Honestly, that was the worst part of the whole transplant, and it wasn't even that bad." From t here t he proc edu re moved quickly. "I didn't get sick," Stephen says. "I think they had fve bags of stem cells, so they put in fve syringes. It took maybe 20 minutes from start to fnish, which sur- prised me." After that it was just a matter of wait- ing. "They give your stem cells to you, but the chemo is still working, so your blood counts are still dropping," Stephen says. "You're just a walking petri dish waiting for infection at that point." cftSp#23vky.indd 44 2/3/14 11:18 PM