StemCell Therapy

Submitted By:JasonWaterman, M.D.

Published online: January 2009

Autologous stem cell transplantation (ASCT) is now commonly used to treat a variety of illnesses including multiple myeloma, Hodgkins lymphoma, and non-Hodgkins lymphoma (see Stem Cell Transplant by Dr. Matt Kalaycio http://www.cancernews.com/data/Article/258.asp). The transplant process has multiple steps including preparation prior to transplant, the transplant with post-transplant hospital observation, and long-term observation. Each step in the process has its own complications, and thus requires close monitoring to quickly identify and treat any problems. This article focuses specifically on the identification and management of complications of ASCT.

Prior to autologous transplantation a thorough evaluation will take place by an oncologist including a history and physical examination, lab testing, imaging, bone marrow biopsy, and a social work consultation to determine a patients readiness for transplantation. Once a decision to pursue transplantation is made, a sufficient number of the patients stem cells are collected in order to have enough stem cells to reestablish the immune system after transplantation.

To make the collection of stem cells easier, the patient is given a medication called granulocyte-colony stimulating factor (G-CSF) for 4-5 days prior to collection to stimulate the bone marrow to produce and release more stem cells into the blood stream. Certain chemotherapy agents may also be used in this process to ensure that the highest possible number of stem cells are collected. The stem cells can be taken from the bone marrow or from the peripheral blood.

Collection of stem cells from the bone marrow proceeds just like a bone marrow biopsy and the extracted liquid marrow then undergoes processing to isolate the stem cells needed for transplantation. The process used to collect the stem cells from the blood is called leukopheresis. Leukopheresis involves taking blood from a patients vein and passing it through a machine that will remove the stem cells needed for transplant before returning the blood back to the patient through the vein. Either process takes a few hours and may need to be repeated in order to collect enough stem cells.

Stem cell collection is most often done as an outpatient procedure and generally results in few complications, which are mostly mild and easily reversible. The most common complications of leukopheresis include a drop in blood pressure (hypotension), dizziness, numbness and tingling, nausea, vomiting, and fever. Bone marrow collection can also be complicated by soreness and bleeding at the site of collection, which rarely requires blood transfusion. Treatment for hypotension and dizziness is usually accomplished by giving the patient intravenous fluids to bolster the blood pressure during the collection. Calcium is infused if numbness and tingling occur. Nausea and vomiting are common and multiple medications are available for treatment. Fevers are common, generally mild, and most often short-lived. Fevers associated with stem cell collection frequently respond to acetaminophen, although a small number of patients may need to have their blood evaluated to make sure there is no underlying blood stream infection.

When enough stem cells have been collected and it is time for transplantation, the patient is admitted to the hospital and begins a process called conditioning, or myeloablation. The goal of conditioning is to destroy the cancer cells in the body by administering high doses of chemotherapy with or without radiation therapy. The most dangerous side effect of conditioning is that the patients natural immune system is destroyed in the process. This is the portion of the transplant process which is the most important in terms of outcome for the patient, because complications at this stage of transplant are potentially fatal. The next step is then the infusion of stored stem cells back into the patients blood stream to regenerate the patients natural immune system.

Short-term side effects from the actual transplantation of stem cells include fever, chills, hives, chest tightness, hypotension, and coughing. Usually these are mild, and the transplant is rarely stopped because of these symptoms. Once in the blood stream, the stem cells travel to the bone marrow where they will stay and begin to produce all the bodys different blood cells in a process called engraftment. The process of engraftment can take 2-4 weeks, and full reestablishment of the immune system may take several months. The common complications during engraftment revolve around the lack of appropriate numbers of blood cells from the conditioning process, as well as toxicities from the conditioning agents themselves.

Visit link:
Complications of Autologous Stem Cell Transplantation

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