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Stem Cell Transplant Program

The Stem Cell Transplant program was established in 1987 to provide high-quality, innovative care by putting patients and their families first and by advancing the biology of stem cell transplantation. Our program is the leader in volume and types of transplants, averaging 100 transplantations per year, resulting in survival rates consistently exceeding the national survival rate.

About Stem Cell Transplant
Stem cells are immature cells that develop into red blood cells, white blood cells, platelets and more stem cells. Most stem cells are found in bone marrow, the spongy tissue inside large bones, but stem cells are also found in the blood stream. The stem cells found in bone marrow and blood are hematopoietic (blood-forming) stem cells, not embryonic stem cells. Stem cell transplantation is a transfusion of stem cells given to patients whose stem cells and bone marrow have been destroyed by chemotherapy or radiation therapy.

How Is It Different From Bone Marrow Transplantation?
Stem cell transplantation and bone marrow transplantation are different only in the way that the stem cells are collected. In bone marrow transplantation, bone marrow is collected from the hip bone in a surgical procedure. In stem cell transplantation, stem cells are collected from the blood stream through a process called apheresis.

Types Of Stem Cell Transplant
There are three types of transplant, based on donor source.

  • Autologous
    You are your own donor.
  • Allogeneic
    Stem cells are donated by another individual. The donor may be a sibling, other family member or an unrelated individual.
  • Syngeneic
    The donor is your identical twin.

The type of transplant that is best for you will depend on your disease, the availability of a matched donor, your age and your general health status.

Stem Cell Transplant Process
First Contact
You or your referring physician may call Northwestern Memorial at (312) 926-5400 to learn about the Stem Cell Transplant Program and to answer questions to determine if you are a candidate for stem cell transplantation. Be prepared to answer questions about the following:

  • Type and stage of your cancer
  • Your current medical condition and history
  • The name of the physician who referred you
  • Your medical records
  • Your insurance coverage

Evaluation
If you are considered a possible candidate, you will be scheduled for an in-person evaluation within one to two weeks of your first contact to determine if you could benefit from the procedure. Please bring medical records and a companion for support.

If you are not a candidate for transplant, our staff will discuss the reasons and will offer recommendations and possibly suggest more testing.

If you are accepted as a possible transplant patient, our staff will arrange pre-testing for you.

Pre-testing
A series of medical tests will be performed to provide important information about your disease and the condition of key organ systems. Decisions about the most effective and appropriate protocols for you are based on this test information. Pretesting takes one to two days, although additional time may be needed depending on required tests and test outcomes.

Tests:

  • Blood tests - Testing for exposure to viruses and for liver, kidney and blood cell function
  • MUGA scan - Measures heart function
  • Pulmonary function test - Measures lung function
  • Chest X-ray
  • Dental exam
  • PPD - Skin test for tuberculosis
  • EKG - Testing the rate and rhythm of your heart
  • Urinalysis - Checking for infection and pregnancy
  • Psychosocial evaluation - Evaluating your emotional preparedness and availability of support systems

Possible additional tests:

  • CT scans
  • X-rays
  • Lumbar puncture
  • Bone marrow biopsy and aspirate

Harvesting
Reinfusion
Reinfusion is when the donated stem cells are transplanted into the patient. The procedure lasts 30 minutes to three hours, depending on the volume of cells. A companion may accompany the patient during infusion. Possible side effects include:

  • Pink-tinged urine
  • Fevers
  • Chills
  • Allergic reaction (hives, itching, shortness of breath) to the preservative mixed with the stem cells
  • Nausea, vomiting, diarrhea
  • Taste and smell of garlic

Engraftment
Engraftment is the process where transplanted stem cells migrate to the bone marrow cavities and begin to produce new white blood cells, red blood cells and platelets. The process takes one to three weeks for white blood cells to produce and 10 days to four weeks for red blood cells and platelets to produce. During engraftment, the flowing treatments are performed:

  • Medications
    Growth factor medications may be given to help engraftment. Antibiotics are given to prevent infections.
  • Transfusions
    Since the body is not yet able to produce blood cells, transfusions of red blood cells and platelets will be given as needed.
  • Nutrition
    Adequate nutrition is important but may be difficult due to nausea and loss of appetite. Our nurses, dietitian and pharmacist collaborate in addressing nutritional needs.
  • Monitoring
    Because patients are vulnerable to side effects and infection during the waiting period, your status will be monitored frequently through measurement of blood levels, vital signs, weight and fluid status. Patient and staff will both be alert to early signs of complications.
  • Activity
    Staying active through walking in the halls or riding the stationary bike can help reduce fatigue, improve appetite and lower infection risks.
  • Self-Care
    Instruction about hygiene practices to lower the risk of infection will be provided. Hygiene practices include bathing daily, using only electric razors and using special toothbrushes and mouthwash.

Possible side effects and complications include:

  • Short-term side effects, often resulting from the chemotherapy, radiation or medications, include:
    • Nausea, vomiting, diarrhea, loss of appetite
    • Hair loss
    • Mouth sores
    • Skin reactions
    • Fatigue
  • Potentially serious complications, elated primarily to low blood counts, including:
    • Infections
    • Bleeding

You and the staff will carefully monitor for signs of all types of infection and bleeding. There are many treatments available that can help with these complications, but they are most effective if the complication is caught early.

 

  • Organ complications, including problems developing in the following organ systems caused by chemotherapy, radiation, or medications:
    • Liver, including veno-occlusive disease (VOD), hepatitis, and infections
    • Kidneys, including kidney failure
    • Lungs, including inflammation and congestion
    • Heart, including reduced pumping ability

As with other complications, the staff will help you be alert for signs of these organ complications so treatment may begin as soon as possible.

  • Graft versus host disease (GVHD), is a potentially serious side effect of allogeneic transplant. In GVHD, the donor stem cells recognize that the recipient cells (your cells) are different and attack them. GVHD may be acute or chronic, and may affect the skin, liver, or gastrointestinal tract. Drugs are given to reduce the likelihood of GVHD and to treat it if it does occur.

Recovery
What is recover?
Recovery is the long-term process of regaining blood cell production and immune function as well as strength, energy, and appetite following a stem cell transplant. The recovery process may last for months, even years, until your body has reached its highest possible level of functioning.

When will I be discharged from the hospital?
Your physicians will determine your readiness for discharge based on your blood counts, your nutritional status, and your overall level of health. Most patients are discharged in the 3rd or 4th week after the transplant.

Is there follow-up medical care after I leave the hospital?
Initially, you will be seen at least weekly in the Stem Cell Transplant Clinic, located on the 14th floor of Galter Pavilion. These weekly visits will continue until post-transplant complications are resolved, which could be a few weeks to several months. At that point, your care may be transferred to your referring physician for continued monitoring, or your care may be shared between your referring physician and the physicians at Northwestern Memorial.

During each clinic visit, your blood levels and medication status will be reviewed, and you will be evaluated for any new symptoms of side effects or complications. The physician and nurse will be glad to answer questions at any time.

You may be offered home health care during recovery, particularly for transfusions and blood draws in your home. The staff of stem cell transplant will schedule your clinic appointments and arrange for home health care, if needed.

How will I care for myself at home?
Stem cell transplant patients continue to be at risk for infection and complications for months or longer after transplant. You will play a very important role in the recovery process by following the self-care guidelines you will be given by the stem cell team.

  • Infection precautions
    You will be given specific information about precautions you should take and symptoms that may be cause for concern. Most patients are encouraged to avoid crowds, gardening, pets, and contact with people who are ill. Since your skin is the first line of defense against infection, careful skin care is also essential.
  • Home environment
    Your home will need to be thoroughly cleaned before your return, and you will be encouraged not to perform housecleaning functions for some time. You will also be given guidelines about handling pets and plants in the home.
  • Nutrition
    Good nutrition plays an important role in your recovery. Our dietitians will give you information about foods likely to be appealing to your appetite as well as helpful in your recovery.
  • Physical activity
    Throughout your transplant, it is important to get enough exercise to build your strength. When you return home, you will be encouraged to continue with some type of daily activity. The staff will help you find the types and amount of activity which supports your recovery.
  • Visitors
    For at least the first few weeks at home, your immune system will still be fragile and you will tire easily. For these reasons, it is best to limit the number of visitors and to be sure that all visitors are in good health. The staff of the Stem Cell Transplant Program will give you specific information about these and other ways you can protect and care for yourself during the recovery process.

Resuming Life
It is natural for you to have many questions about how and when you will be able to resume your life. Most patients wonder about when they will be able to return to work, to resume sexual activity, to drive. You will most likely have questions also about your long-term medical and physical status.

The answers to each of these questions will be different for each person. The staff will be available to you throughout this process to anticipate concerns, to provide suggestions and support and to answer questions.

Stem Cell Transplant Resources
Patient Intake Form (pdf)
What to bring to your evaluation
Enjoying your stay

Contact
Stem Cell Transplant Program
(312) 926-5400
Stem Cell Transplant Social Worker
(312) 926-6331

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