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
46 cancer fighters thrive | spring 2014 cf thrive. com diseases that require allogeneic transplanta- tion are much more diffcult to treat," Dr. Abutalib says. "It is tough. It has very good results if it's done at the right time to the right patient with the right donor, but there are risks. Therefore a comprehensive discus- sion with the patient and family members is a high priority. Recovery Period Recovery from stem cell transplantation varies depending on the type of transplant. Though they do not have to be completely isolated after they leave the hospital, pa- tients recovering from a transplant must take precautions to prevent infection—such as avoiding large crowds, sick people and small children. With autologous transplantation, pa- tients need to follow restrictions for six to eight weeks. Stephen explains that he has to avoid shaking hands, being around sick people and letting the dog lick his face. "I am still able to live my life. I just wear a mask, and I have hand sanitizer," he says. "A stem cell transplant's biggest friend will be hand sanitizer and common sense." According to Dr. Topolsky, most patients recover from autologous transplantation within six to 12 weeks and can even return to work at that time. The restriction period and the recovery period for allogeneic transplantation are longer. The restrictions to prevent infection can be in place for six to 12 months—or even longer if a person has GVHD. "It takes six months to a year under the best of cir- cumstances for the immune system to get back to normal," explains Dr. Topolsky. "If a patient develops GVHD, the response is even slower and they are on medications a lot longer, sometimes forever. The goal is to get people off immunosuppression within six months, though." Side Effects As with any medical procedure, stem cell transplantation can have complications— including mouth sores, nausea, vomiting, digestive problems and, of course, GVHD with allogeneic transplantation. Stephen says that another side effect he experienced is a signifcant loss of strength. "I was told that I could expect to lose about 7 to 8 percent a day," he says. "Before I went in, I could bench-press 300 pounds, now I can barely do 185 pounds." The other lingering side effects he has no- ticed are digestive issues, which prevent him from eating large meals, and fatigue. "Some days I'm so tired that I feel like I just fnished a marathon," he explains. "It hits me fast and I just collapse and sleep and sleep." Outcomes The outcomes of stem cell transplantation are generally good. The mortality rate for autologous transplantation is 2 to 3 per- cent, compared with 20 to 30 percent for allogeneic transplantation. Dr. Topolsky explains that the main reason a patient may die after autologous transplant is re- lapse of the cancer, whereas the main rea- son a patient may die after an allogeneic transplant is infection related to the treat- ment of GVHD. "Over the past fve years, the rate of al- logeneic transplants in the United States has been going up, which means that people are getting more comfortable with the procedure and outcomes are probably improving," Dr. Abutalib says. "In con- trast, the rate of autologous transplants is trending down because the data are show- ing that it's not as good in some diseases anymore mainly because of better drugs. For instance, the transplant rate in mul- tiple myeloma has gone down dramatically over the past couple of years." The Big Picture The bottom line: stem cell transplantation has become more common and is a viable option for some patients. Some patients are intimidated by the idea of a transplant, but Stephen says the anticipation and the hype are far worse than the reality. He encour- ages patients to research the procedure and to select the right care team. "You have to fnd the right hospital and have confdence in your team. And you have to keep your spirits up. If you can't do that, you will have a terrible time. It's a mental game. Attitude is so important in this." No case is typical. You should not expect to experience these results. RESOURCES Be The Match bethematch.org Find a donor or register to be a donor. National Bone Marrow Transplant Link nbmtlink.org The National Bone Marrow Transplant Link helps patients, caregivers and fami- lies cope with the social and emotional challenges of a bone marrow/stem cell transplant from diagnosis through survivorship. The Leukemia & Lymphoma Society lls.org The Leukemia & Lymphoma Society is dedicated to funding blood cancer re- search and providing education and patient services. cftSp#23vky.indd 46 2/5/14 9:06 AM