Stem cells are the cells in our body that create new cells. These cells can be used to treat conditions such as cancer using specific procedures.
Hematopoietic stem cells are located in your bone marrow and are able to create the three types of blood cells in our body – platelets, white blood cells and red blood cells.
“They are like the mother cell of the blood line because they are able to renew and differentiate into these different cells,” said Dr. Arlene Gayle, oncologist/hematologist and medical director of the autologous hematopoietic stem cell transplant program at Marshfield Clinic Health System.
Hematopoietic stem cell transplants can treat these cancers:
- Plasma-cell diseases
- Non-Hodgkin’s lymphoma
- Hodgkin’s lymphoma
- Other cancers such as testicular cancer
Before your transplant
Before a stem cell transplant, your doctor conducts an initial evaluation to see if you are a candidate. This includes:
- Taking a biopsy of your cancer to make sure the cancer is sensitive to chemotherapy.
- Making sure any chronic illnesses are controlled. Checking to make sure you do not have infectious diseases.
- Making sure your organs can handle a transplant.
We need to know what is going on with the patient before we move forward with the transplant,” Gayle said.
Once you can move forward with the transplant, your care team works with your insurance company to get the procedure covered by insurance and begin scheduling the treatment.
Collecting stem cells
A doctor first needs to collect the hematopoietic stem cells to treat cancer. This used to require going into the bone marrow, but doctors now collect hematopoietic stem cells by straining them out of your blood.
There are three ways to get stem cells:
- Autologous: A doctor collects your own stem cells.
- Allogeneic: A doctor collects stem cells from someone with similar stem cells.
- Syngeneic: If you have a twin, a doctor collects stem cells from your twin.
Transplanting your stem cells
Once the stem cells are collected, you undergo high-dose chemotherapy in a hospital to kill your cancer. This process also kills your stem cells and bone marrow. Depending on your type of cancer, different doses of chemotherapy are used.
The chemotherapy can cause serious side effects that are managed adequately by your transplant team. Some of these are:
- Mouth sores
- Mucositis (inflammation and ulceration of mucous membrane of the digestive tract)
- Lethargy or weakness
- Poor appetite
Doctors infuse the hematopoietic stem cells back into your body 24 hours after finishing chemotherapy.
These stem cells go to the bone marrow to create red blood cells, white blood cells and platelets.
It typically takes 10-14 days for your body to make their own red and white blood cells, and platelets. As you wait for your blood count to recover, your transplant physician transfuses red blood cells or platelets into your body to support you until your bone marrow makes your own.
During this time, you are extremely susceptible to an infection. You will receive antimicrobials while recovering in a hospital to reduce the chance of an infection.
It is a really crucial and critical time, and that is one of the reasons we have trained transplant staff that will take care of the patient during that time,” said Gayle.
Once you are cleared to go home, you will have periodic check-ups for the next year. Because this process also wipes out your immune system, you need to receive certain childhood vaccines again. You also need to rinse your mouth, wash your hands a lot and be cautious of situations that could cause infections for up to two years.
Finding a quality program
A quality hematopoietic stem cell transplant program should be Foundation for Accreditation of Cellular Therapy (FACT) accredited.
FACT inspects all aspects of the program every three years, including looking at the certifications and qualifications of the doctors on the team.
Your transplant team could include oncologists/hematologists, intensivists while you are in the hospital, various specialists if your treatment has complications and many support staff members.
“It is a team approach. We are all transplant-knowledgeable and trained and know what to look for,” Gayle said.
Many programs also offer transplant-related clinical trials. For more information about hematopoietic stem cell transplants, talk to your hematologist/oncologist.