Patient Education...

Evaluation - Upon referral, the patient meets with Dr. Maharaj, who reviews the patient's medical history and consults with the referring oncologist.  A clinical team then evaluates the information to assess whether the patient has met the criteria and is eligible for a transplant.

Administration and Education - The administrative staff at the South Florida Bone Marrow Stem Cell Transplant Institute facilitates insurance arrangements for the patient and provides assistance with lodging if necessary.  The patient receives a complete orientation of the transplant process, and is given educational materials and information regarding patient support services.

Induction - The patient receives conventional doses of chemotherapy under the supervision of a referring oncologist.  Transplant eligibility is further evaluated based on the cancer tissue's sensitivity to chemotherapy.

Mobilization - The patient receives chemotherapy at five times the conventional dosage for three to five days.  Stimulating drugs for stem cell growth are given to the patient simultaneously via a catheter.

Harvest and Storage - Once the stem cell count in the peripheral blood reaches acceptable levels, daily harvesting sessions begin collecting the needed number of stem cells for transplant.  Collected cells are processed, cryo-preserved (frozen), and stored until time of transplant.

High Dosage Chemotherapy - When the patient recovers from mobilization chemotherapy, he or she receives high-dose chemotherapy at ten times the conventional dosage for five to seven consecutive days.  During this process, the patient becomes severely immuno-compromised, and is monitored by the transplant team 24 hours a day at the Institute and by the home-care nursing team.

Transplant - The reinfusion of stem cells takes place 48 hours following high-dose chemotherapy.  Stem cells are reintroduced into the bloodstream through a central line.  Once reintroduced, they begin to produce new blood cells.

Recovery - This period generally lasts two weeks.  The patients blood count returns to normal levels and the immune system recovers.

Follow-up - Patients return for weekly follow-up visits for the first month post-transplant, and then at the third and sixth months.  After that, annual visits are scheduled.


BMSCTI Affiliates:  click here

 

Q: What is bone marrow and what are stem cells?

Bone marrow is the soft, sponge-like material found in the bones.  Its main function is to produce primitive or immature cells called stem cells (also called "progenitor cells").  These cells have the ability to divide into more stem cells or into white blood cells (WBCs), red blood cells (RBCs), and platelets, depending upon the body's needs at that moment.

White blood cells (also called "leukocytes") help the body defend itself against infection and other disease, by destroying "foreign" substances such as bacteria or viruses.  When infection is present, the body increases the production of the WBC.  When the number of WBC in the blood is low, the body has a more difficult time warding off infection.

Red blood cells (also called "erythrocytes") carry oxygen, with the aid of a protein called hemoglobin, from the lungs to cells in all parts of the body.  Oxygen helps process the nutrients from the food that we eat. RBCs also carry back carbon dioxide (considered "waste material") from the cells to the lungs.  When the number of RBC in the blood is low, a condition called anemia results.

Platelets help the blood to clot and thus, preventing bleeding.   Low number of platelets in the blood (a condition called thrombocytopenia) may cause easy bruising and bleeding.

In adults, stem cells can be found mostly in marrows of the bones of the skull, back, chest, hips and upper arms and legs.  In children, they can be found throughout most of the marrows.  Stem cells, however, can also be found circulating in the blood throughout the body and are called peripheral blood stem cells.

Q: How are bone marrow and stem cells obtained for the transplant?

Bone marrow and stem cells can be obtained or "harvested" from the patient (autologous) or from another individual (allogeneic), but are always collected before very high doses of anti-cancer drugs (chemotherapy) and/or high energy rays (radiotherapy) are administered. 

Bone marrow is usually taken from the hip bones (pelvis) using a large needle or a special syringe inserted several times into the pelvic bone through small incisions to draw out the marrow. The "harvested" marrow is then processed to remove blood and bone fragments. This process of obtaining stem cells is also called aspiration, which may require local or general anesthesia, and is usually done in the operating room.  It may require the patient to stay in the hospital for 1-2 nights, but some hospitals can perform a bone marrow harvest as an outpatient.  The site of the needle puncture will be tender for about a week with slight scars forming.   The patient or donor may feel some mild stiffness and soreness but can be lessened through exercise and pain medication.

A newer method of collecting or harvesting stem cells is called apheresis or leukapheresis.  Blood is obtained through a line (central venous catheter) inserted into a large vein and passed through a machine that removes stem cells.   The rest of the blood is returned to the patient.  The process may take 2 to 4 hours, and usually does not require staying in the hospital overnight.  There are fewer stem cells circulating in the blood when compared to those found in the marrow.   Transplant physicians are therefore looking into ways to increase the number of stem cells that can be harvested. By giving the patient "growth factors" (substances that are naturally produced by the body but can also be made in laboratories), the transplant physicians help stimulate the body to make more stem cells.  Since only a small amount of marrow or stem cells are removed, the procedure seldom poses significant problems or results in bad side effects.

Q: How are stem cells used for the transplant?

Once the stem cells are obtained, the marrow or stem cells are either preserved and frozen until needed (in an autologous transplant) or are given to the recipient almost immediately (in an allogeneic transplant).  

The patient is then given very high doses of anti-cancer drugs and/or radiation (called "conditioning") to get rid of the cancer cells throughout the body; to make space for the new marrow and; in an allogeneic transplant, to reduce the risk of the patient rejecting the cells or marrow taken from another person.  The bone marrow or stem cells that were previously collected are given to the patient through a central venous catheter to help re-grow normal blood cells and reduce the chance of severe infection, bleeding, or anemia.

Q: Is there any evidence of success for stem cell/bone marrow transplant?

As improvements are being made in the way the procedure is done, stem cell/bone marrow transplantation is becoming more commonly accepted and effectively used in treating many cancers and leukemias.  Researchers are finding better results in the use of stem cell/bone marrow transplant in patients with breast cancer, Hodgkin's disease, non-Hodgkin's lymphoma, leukemia, multiple myeloma, neuroblastoma and testicular cancer. 

In addition, the BMSCTI  transplant team is investigating the use of stem cell/bone marrow transplant in many other cancers including sarcomas, brain tumors and ovarian cancer.  The transplant team is also looking at the role of hematopoietic growth factors (also called "colony-stimulating factors" or CSFs), which are proteins that help the stem cells develop into blood cells, (a) in increasing the number of stem cells that can be harvested during apheresis, (b) in helping the stem cells develop into mature blood cells quickly, thus preventing life-threatening infections, anemia or bleeding, (c) in stimulating the growth of platelets in order to complement or replace platelet transfusion, thus cutting down the number and the costs of required transfusions, and (d) in stimulating the growth of red blood cells (RBCs), thus reducing the need for and the costs of RBC transfusions.


Criteria for Hospital Admission:

  • Hypotension

  • Bleeding

  • Infection

  • Cardiac Failure; Cardiac Arrhythmia

  • Respiratory Distress

  • Severe Renal Insufficiency

  • Neurological Dysfunction

  • Intractable Nausea, Vomiting, Diarrhea, and Fluid Depletion

  • Psychiatric Emergency

  • Severe mucositis not contrtolled with analgesics which can be given at home.

  • Any other complication that cannot be treated in the outpatient setting or manageable in the home environment.

 




Above:  Dr. Maharaj discussing a patient case with the pharmacist at the institute.



History of Bone Marrow Transplants

Bone marrow/stem cell transplant procedures have been around since the 1970's, but were not widely accepted in the United States until the mid to late '80's.  Today, BM/SCTs are utilized to treat a variety of blood disorders and cancers including acute and chronic myeloid leukemia, multiple myeloma, Hodgkin's disease, non-Hodgkin's lymphoma, germ cell tumor, breast cancer, and ovarian cancer.  

The beneficial effects of BM/SCTs have been well documented through outcomes studies. For each disorder, the disease-free survival rates for transplant patients are significant when compared to patients receiving conventional chemotherapy.


What Lies Ahead?

The future of BM/SCT procedures are being investigated for curative use in other areas, such as autoimmune diseases (e.g., rheumatoid arthritis and lupus) and neurologic disorders (e.g.,multiple sclerosis).  The procedure appears promising for these disorders ironically because of its immunoablative effects, as high-dose chemotherapy can diminish overactivity of the immune system that characterizes certain autoimmune and neurologic disorders.  As the procedure is expanded to treat diseases other than cancers, the number of people who can benefit from BM/SCT will increase.




Bethesda Support Groups

Bethesda Memorial Hospital offers a variety of support groups to help individuals, families, and friends understand and cope with life experiences.  All groups meet at Bethesda Memorial Hospital unless otherwise noted.

Al-Anon

For families and friends affected by alcoholism. Each Friday at 8:00pm. Call 278-7733 or 737-7733, ext. 4405. Offered in cooperation with Bethesda Memorial Hospital.

Anxiety Support Group

Meets every Tuesday from 6:30pm to 8:00pm. Call 737-7733, ext. 4405. Offered in cooperation with Bethesda Memorial Hospital.

Breast Cancer Support Group

Information, discussions and support for people with breast cancer. Family and friends welcome. 3rd Tuesday of each month from 5:30-7:30pm. Call Leslie Pollart, RN, at 737-7733, ext. 4540.

Coping With Cancer

Support and educational programs for cancer patients and their support persons. Each Tuesday at 4:30pm. Call 278-7733 or 737-7733, ext. 4181.

Nicotine Anonymous

Support and information for people who wish to stop smoking. Each Friday at 7:00pm. Call 737-7733, ext. 4405. Offered in cooperation with Bethesda Memorial Hospital.

Parent to Parent Support Group

Designed to meet the needs of families with special needs children. Meets at Bethesda Health City every other Tuesday from 10-11:00am, Conference room "C". Call Pam or Randee at 842-3213.

Partners Against Cancer Support Group

Information and support are provided for all cancer patients and their support persons. 1st Tuesday of each month at 5:30pm. Call Nancy Johnson at 737-7733, ext. 4177.

Prostate Support Group

Support for prostate cancer patients, families and friends. 2nd Wednesday of each month at 5:30pm. Call 278-7733 or 737-7733, ext. 4181.

Stroke Club

Survivors of stroke, friends and family share experiences and help each other cope with feelings. 1st Sunday of each month at 1:00pm. Call Nancy Spence, 278-7733 or 737-7733, ext. 4960.

Trigeminal Neuralgia Assoc. Support Group

Meets May 21, September 10 and November 12 in the Dolphin/Manatee rooms at 1:30pm. Call Lucy Childs at 733-6930 for information. Offered in cooperation with Bethesda Memorial Hospital