Welcome to UAMS and the Winthrop P. Rockefeller Cancer Institute Stem Cell Transplant Service.  This information was written to help you learn more about an allogeneic stem cell transplant, why you will need special care and what you and your family can do.  Please read it carefully.  The doctors and nurses will review this with you and answer your questions.  All of your questions are important.

The Allogeneic Transplant Team

Our Allogeneic Transplant Service works as a team.  The doctor that you see in the clinic may not be the one who will take care of you while you are in the hospital.  Transplant doctors rotate on and off the inpatient unit.  They are often on for two weeks, but not always.  During that time, they manage all of the allogeneic transplant patients 24 hours a day.  At the end of the two weeks, another attending doctor takes over.  While you are an inpatient, the inpatient attending will be in charge of your day-to-day care.  However, if any major problems come up while you are in the hospital, the inpatient attending doctor will discuss them with your primary transplant doctor.  Once a week, all of the attending doctors meet to discuss your progress.

Many people will be involved in your care on the inpatient unit.  You will have a primary team of nurses.  A nurse practitioner and a clinical nurse specialist may see you from time to time.  You will see many doctors.  Some will have finished their medical resident training and are doing specialized training in hematology.  These are called fellows.  You will also see doctors who are still in training.  These are called interns and residents. The attending doctor supervises them.  A case manager will help to plan for anything you need when you go home.  A social worker will help you with everything from feelings of sadness or loneliness to financial concerns.  Nursing assistants will help you bathe and dress.  They will also check your weight and vital signs each day.

Once you are discharged from the hospital after your transplant, you will be followed closely in our outpatient department by your primary attending, nurse practitioners and ambulatory care nurses.  They will monitor your recovery and administer medications, transfusions or fluids as you need them.  At first, you will be seen frequently. Over time the visits will be spaced farther apart.  Your doctors and nurses are available by phone to help with any questions or problems that occur between visits.

Ongoing follow up care after transplant is very important to make sure you achieve the best possible health.  At some point after your transplant, you may be referred to our survivorship nurse practitioner.  The aim of this nurse practitioner is to assist your general recovery and manage the effects of cancer treatment and transplant. The survivorship nurse practitioner is part of the transplant team and works closely with your attending and nurses to ensure your recovery.

What Stem Cells Are

Blood-forming stem cells are cells that will grow or mature into different blood cells.  They make all of your red blood cells, white blood cells and platelets.  Red blood cells carry oxygen throughout your body, white blood cells fight infection, and platelets help your blood to clot and control bleeding.  Stem cells are also known as pluripotent or progenitor cells.

Where Stem Cells Are Found

The cells used in stem cell transplants come from one of three sources:

  • Bone marrow
  • Your blood stream – these are called peripheral blood stem cells
  • The umbilical cord and placenta of newborn babies.

Bone Marrow Stem Cells

Bone marrow is a spongy substance found inside larger bones.  It resembles blood and is a rich source of stem cells. Stem cells can be taken from a donor’s bone marrow. This is called a bone marrow harvest. It is done with general anesthesia in the operating room. The donor usually goes home the same day of the procedure.

Peripheral blood Stem Cells

Stem cells may also be found in the bloodstream. Before stem cells are collected from the bloodstream, the donor is given a growth factor to stimulate the bone marrow to make more stem cells. Usually, this drug is G-CSF. Other names for G-CSF are Neupogen and filgrastim. The donor takes this medicine by injection. Some of the new stem cells will leave the bone marrow and move into the bloodstream. The nurse will teach the donor how to give the injection and tell him or her how often it must be done. After a scheduled number of doses of G-CSF, the donor has the stem cell collection.

The stem cell collection process is similar to donating blood. The donor has an intravenous (IV) line in each arm.  Blood is removed from one arm, put through a blood filtering machine, which removes the stem cells, and then returned to the donor through the IV in the other arm. This is called apheresis. Umbilical Cord Blood Stem Cells

Umbilical cord blood is another source of stem cells. At birth, the cord blood is collected from the umbilical cord and placenta and taken to a cord blood bank. It is tissue-typed, processed, and stored frozen until needed for a transplant.

Cord blood from one infant provides a limited amount of blood stem cells. It is sometimes not enough for adult or larger patients, who may need more stem cells. In this situation, we will frequently use two cord blood units from two different babies. Both cord blood collections will be infused on transplant day.

What an Allogeneic Stem Cell Transplant Is

An allogeneic stem cell transplant replaces your stem cells with new, healthy ones from a donor. “Allogeneic” means that the stem cells come from a donor other than yourself. You will have chemotherapy, radiation therapy, or both to kill your cancer and suppress your immune system. This will damage your normal bone marrow. You will then receive the transplant of the donor stem cells. They are given into a vein, usually through your central venous (IV) catheter. They may be infused from a bag, like a blood transfusion, or from a large syringe attached to your catheter. This will take place in your hospital room.

Stem cell transplants are used to treat many diseases. These include leukemia, lymphoma, myeloma, aplastic anemia, other tumors, and immune deficiencies that are present from birth. The care you need before a transplant depends on your disease. Your doctor will tell you why a transplant is used, why you cannot use your own stem cells, and what treatment plan is best for you.

The Donor

Not everyone can be your donor. The right donor is someone whose tissue type most closely matches yours. Tissue typing is based on your human leukocyte antigens (HLA). These are found on the surface of your white blood cells.

They are important for immunity because they help your body recognize your own cells so they do not attack them. If foreign cells enter your body, your white blood cells will see them as foreign and will mount an attack to get rid of them.

A person with close HLA match is most often a brother or sister. Family members will have a blood test to see what tissue type they have. The person whose tissue type is most like yours is chosen to be the donor. If no one is a close match, your doctor will help you start a search with a donor registry, cord blood banks, or both. The donor gives stem cells for the transplant and may also be needed to donate platelets after the transplant.

People who are not related can have a close match by chance. If you do not have a family member with a matching tissue type, we look for an unrelated adult volunteer donor or cord blood units. The National Marrow Donor Program has millions of people registered who have had their blood typed for this purpose. However, the search for a donor may take weeks or even months to complete. If you will need stem cells from someone who is not related to you, your doctor will give you a more detailed explanation.

Myeloablative Transplant versus Non-Myeloablative Transplant

There are two approaches to treatment before an allogeneic transplant. One is called myeloablative. In this approach you receive high doses of chemotherapy with or without radiation. These treatments aim to kill your cancer but also kill (myeloablate) all stem cells in your bone marrow. The donor stem cells will then replace the ones killed by the treatment. This form of treatment is very intense and it may not be suitable for all patients.

Another approach involves a less intense treatment. It uses lower doses of chemotherapy with or without low doses of radiation. It also includes drugs that suppress your immune system. This type of transplant is called a nonmyeloablative. It aims to keep you immune system and stem cells in check rather than destroying them. This will still allow the donor stem cells to “engraft” in most cases.

Your doctor will consider many factors when choosing which type of transplant is best for you. These include your disease, other treatments you have received, and you general health status. Your doctor will discuss these factors in detail with you.