TRAINING and EDUCATION
Patient Education
The Lymphoma Research
Foundation (LRF) offers patients
with lymphoma and chronic
lymphocytic leukemia a wide
range of resources that provides a
comprehensive overview, as well
as addresses treatment options,
the latest research advances, and
ways to cope with all aspects of
lymphoma.
LRF also provides many
educational activities, from
in-person meetings to
teleconferences and webcasts,
as well as an Understanding the
Hematopoietic Cell Transplantation
Process booklet, e-Updates that
provide the latest disease-specific
news and treatment options,
and an award-winning mobile
app (Focus on Lymphoma) that
provides tools to help manage the
disease.
For more information about any
of these resources, visit LRF’s
website at www.lymphoma.org
or contact the LRF Helpline at
800-500-9976 or helpline@
lymphoma.org.
for a bone marrow transplant. Bone marrow hematopoietic cells can be used for both AHCT and AlloHCT.
To remove the stem cells, the person whose hematopoietic cells are being collected (the donor) is
given general anesthesia. A large needle is then inserted into the bone and some of the bone marrow is removed and frozen. The marrow that is
removed (harvested) is passed through a series
of filters to remove bone or tissue fragments
and then placed in a plastic bag from which it
can be infused into the recipient’s vein, usually within a few hours. Alternately, the marrow can be frozen and stored for years.
When it is time for the patient to receive
the hematopoietic cells, the marrow is given through a vein, just like a blood transfusion. A hospital stay of about six to eight
hours after the procedure can be expected
in order to recover from the anesthesia and
the pain at the needle insertion sites.
Peripheral Blood
Hematopoietic cells collected from blood are
commonly used in HCT. Normally, only a few
stem cells are found in the blood. A drug called
granulocyte colony-stimulating factor, or G-CSF
(filgrastim, lenograstim, and pegfilgrastim), is given to
stimulate hematopoietic cell growth and improve the
ability to collect an appropriate number of hematopoietic cells. The hematopoietic cells are collected through
a process called apheresis: the blood is removed through
a catheter, the cells are collected, and the rest of the
blood is returned to the donor. The entire procedure
takes three to four hours but needs to be repeated several times. The hematopoietic cells are treated to remove
contaminants and are then frozen to keep them alive
until the patient is ready to receive them.
Umbilical Cord Blood
After the birth of a newborn, some of the baby’s blood
is left behind in the placenta and umbilical cord. This is
known as cord blood. This blood can be collected and
frozen until needed for later use in an HCT. HCTs with
umbilical cord blood are not as common as those from
other sources. This is because there are a smaller number
of hematopoietic cells present, and cord blood transplants
can take longer to engraft (enter the marrow to replace
the damaged hematopoietic cells) and start working. Umbilical cord blood HCTs can be considered for children or
small-sized adults and in situations where a well-matched
donor could not be found among family members or
those who have signed up to donate.
The Transplantation Process
Once donor hematopoietic cells have been obtained,
patients undergoing hematopoietic cell transplantation
will experience a similar procedure whether they are
undergoing an autologous or allogeneic transplant.
Preparatory Therapy
Transplants are preceded by chemotherapy treatment
to inactivate the immune system and reduce the tumor
burden, killing malignant cells. These preparative treatments are extremely toxic and may contain radiation.
Total body irradiation with etoposide and/or cyclophosphamide chemotherapy may be used. To decrease the
toxicity, the therapy may be “fractionated,” meaning that
the radiation dose is given over several days. In patients
unable to undergo total body irradiation, BEAM (carmustine, etoposide, cytarabine, and melphalan) and CBV
(cyclophosphamide, carmustine, and etoposide) are two
62
ASH Clinical News
commonly
used regimens
Monoclonal antibodies, such as rituximab, may also
be used.
Infusion of the Transplanted Hematopoietic Cells
A few days after treatment, the patient is given the stored
hematopoietic cells. Donor hematopoietic cells are
delivered through the central line – a long, thin tube (intravenous catheter) implanted in the chest near the neck.
Infusing the hematopoietic cells usually takes several
hours. Patients may experience fever, chills, hives, shortness of breath, or a drop in blood pressure during the
procedure. To stimulate the growth of infection-fighting
white blood cells, G-CSF may be given. Additionally,
blood cell replacement, nutritional support, and drugs to
treat GVHD may be used. Hospital stays can be three to
five weeks.
The patient is kept in a protected environment to
minimize infection. Risk of developing a severe, potentially life-threatening infection is highest two to three
days following transplant until the hematopoietic cells
have been able to re-populate the immune system, usually in about two to four weeks.
It is very important for patients to take precautions to
avoid infections, which include ensuring that vaccinations are up to date prior to transplant; washing hands
diligently; avoiding crowds; cooking all food; avoiding
fresh flowers, gardening, and swimming; and not sleeping with pets.
Engraftment
During the first month following transplant, the transplanted cells will start to grow and produce healthy hematopoietic cells that appear in the blood. This process
is referred to as engraftment. Frequent blood tests may
be done to monitor this process. Complete recovery
of immune function may take up to several months for
autologous transplant recipients and one to two years
for patients receiving allogeneic transplants.
May 2016
Cut out and give to a patient
Lymphoma Research
Foundation Patient
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