Stem Cell Transplant for Cancer
Stem cell transplant (SCT) is used as a treatment in for several kinds of cancer, including:
- Multiple Myeloma
- Acute Myeloid Leukemia (AML)
- Non-Hodgkin Lymphoma
- Acute Lymphoblastic Leukemia (ALL)
- Myeloproliferative Neoplasms (MPNs)
- Hodgkin Lymphoma
- Chronic Myeloid Leukemia (CML)
What is Stem Cell Transplant (SCT)?
In a stem cell transplant (SCT), patients get an infusion of healthy blood-forming cells (stem cells). The healthy stem cells may come from the blood of the patient, from a donor, or from the umbilical cord blood of a newborn baby. (When the stem cells come from the bone marrow of the donor, it is called a bone marrow transplant. But stem cell transplants are now much more common than bone marrow transplants.)
A stem cell transplant is an infusion of blood-forming cells, not a surgery. There are two major types of stem cell transplant. A stem cell transplant that uses a patient’s own stem cells that were collected before treatment is called an autologous (or “auto”) stem cell transplant. An allogeneic (“allo”) stem cell transplant uses stem cells of a donor.
Autologous Stem Cell Transplant (“Auto” SCT)
In an autologous (or “auto”) stem cell transplant, your own cells are removed and stored while you get high dose chemo. Auto SCT is most often used to treat lymphomas and myeloma. Often, your stored stem cells will be treated to try to remove any remaining cancer cells. The cells can then be returned into your blood after treatment. The main benefit of an autologous stem cell transplant is that it allows for higher doses of chemotherapy (and sometimes radiation) to kill cancer than would otherwise be safe to give. The stem cell transplant replaces your blood-forming cells that are killed off by the high dose chemo.
Side Effects of an Auto SCT
The risk of serious complications is low with autologous transplants. One problem, however, is that it is hard to separate healthy stem cells from cancerous ones in the patient’s blood or bone marrow sample. So there is a risk of returning cancer cells to the patient during the stem cell transplant.
Allogenic Stem Cell Transplant (‘Allo’ SCT)
If the stem cells come from a donor, it is called an allogeneic (or “allo”) stem cell transplant. Allo SCT is most often used to treat leukemias (such as ALL, AML and CML), myelodysplastic syndromes and myleoproliferative neoplasms. You get chemotherapy (and sometimes radiation) to make room for the donor stem cells. For the fewest side effects, a donor should “match” as closely as possible to your own tissue type. The closest matches are usually relatives, such as a brother or sister. Stem cells can also be donated by matched, unrelated donors. An allo transplant can help treat cancer because the donor cells recognize your cancer as something foreign, and will attack any remaining cancer cells in your body. This is called “graft-versus-tumor” (GVT) effect. When this happens, an allogenic stem cell transplant can sometimes offer a cure, because the incoming stem cells find the small amounts of remaining cancer cells and kill them.
Side Effects of an Allo SCT
A serious side effect of allo SCT is called “graft-versus-host-disease” (GVHD). This happens when the cells from the donor immune system attack your body tissues. Symptoms of GVHD include severe skin rashes, itching, mouth sores (which can affect eating), nausea, severe diarrhea, fatigue, muscle aches, jaundice, and lung damage. GVHD can become disabling or even life threatening. To control this, you may be given drugs that suppress the immune system. Because allogenic stem cell transplants can have life-threatening side effects, they are not for everyone. Be sure you talk to your health care team about the procedure and understand its potential side effects.
Reduced-intensity Stem Cell Transplant (Also known as Non-Myeloablative Allo SCT or a “Mini-Transplant”)
This type of transplant is a modified version of allogeneic transplant, where the cells come from a donor and the chemotherapy or radiation is given at a lower dose. Much of the benefit of this kind of SCT comes from the GVT effect – the donor’s stem cells attacking your cancer cells. This type of SCT is a good option for those patients who, due to age or other medical conditions, may not be able to tolerate an allo SCT with higher-intensity chemotherapy.Reduced-intensity SCT is used to treat some leukemias (such as CLL, CML, and AML) as well as in non-Hodgkin lymphoma.
Is a Stem Cell Transplant Right for Me?
Not all patients are good candidates for transplant. You must be in relatively good health. Previously, patients needed to be under age 65 to qualify for a SCT. However, new methods of doing SCT now allow some older patients to get a SCT.
If your care team thinks a stem cell transplant may work for you, you will work with a new team—a transplant team—to coordinate the treatment and finding a donor. If you will be using a donor, you should meet with your transplant team early on so they can identify a matching donor as soon as possible.
Navigating a Stem Cell Transplant
Before you go through a stem cell transplant, there are many things to consider. Learn the risks and benefits of the SCT that is recommended for you. Learn what to expect from the procedure and how to prepare for it. You’ll also want to know what to expect for recovery and beyond. Ask if your transplant will be done in the hospital or as an outpatient.
- Read all materials given to you by your health care team about what to expect.
- If you are in the hospital to recover, use technology to stay in touch with friends and family. Skype/Facetime, texting, social media, or other tools can help. Ask your doctor if visitors are allowed.
- Learn if you’ll need the help of a caregiver during your recovery period. Ask if there is a social worker or case manager who can help.
- Learn if you’ll need time off of work (and for how long).
- To rebuild energy after the transplant, take naps and be patient.
- Staying active is important. Start slowly with light exercises, build up to walks, then on to strength training as you can.
- Keep antibacterial soap handy for visitors and friends.
- Eat well-cooked foods, pasteurized dairy products, and purified water while your white blood cell counts are low and until you are told that it’s okay to eat raw foods. It can also be important to take Vitamin D.