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Spring 2005

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Bloodless Peripheral Stem Cell Transplant

In 1996, Patricia Ford, MD, a hematologist/oncologist at the Joan Karnell Cancer Center at Pennsylvania Hospital, became one of the first doctors in the country to perform a bloodless peripheral stem cell transplant. This procedure was successfully performed on a patient diagnosed with lymphoma.

This procedure was not only significant because it successfully treated the cancer, but also because it provided a rare cancer treatment option in the Philadelphia region.

The Bloodless Option
The bloodless option is available to patients whose religious beliefs prohibit them from receiving blood transfusions or blood products. Also, patients concerned about blood borne diseases, such as HIV and hepatitis, may prefer the bloodless approach to their treatment. In the past, these individuals have been denied the option of peripheral stem cell transplant. The bloodless peripheral stem cell transplant offers the option of aggressive treatment and improved cure rates.

To better understand bloodless stem cell transplant, it is helpful to understand stem cell transplant in general.

What are Stem Cells?
Stem cells live in the bone marrow. Bone marrow is the soft inner part of the bone, which makes different types of blood cells: red blood cells, which carry oxygen throughout the body; white blood cells, which help fight infection; and platelets, which help the blood to clot.

What is Stem Cell Transplant?
The stem cell procedure acts, not as the treatment itself, but as a supplemental aid to standard treatments, such as chemotherapy.

Patients diagnosed with certain cancers, such as myeloma, lymphoma or leukemia, can have stem cells removed before undergoing intensive chemotherapy treatment. While chemotherapy is designed to destroy cancer cells, normal cells can also be damaged. Stem cell transplant replaces the stem cells that are destroyed by intensive cancer treatment. The transplanted stem cells help restore production of blood cells, which aid recovery and helps improve outcomes.

The autologous or peripheral (blood found in the arteries or veins) stem cell transplant is where the patient’s own stem cells are removed, stored, and returned to the patient’s body after chemotherapy treatment. Since the cells are not foreign to the body, there is less chance for complications or rejection.

Eligibility
While a patient may request the bloodless option based on religious or personal beliefs, there are other factors to consider. Patients who are most eligible for this procedure include:

  • Patients suffering from myeloma, lymphoma or leukemia.
  • Patients requiring high-dose chemotherapy as treatment.
  • Patients who are under the age of 70.

It is important to note that patients over 70 are not excluded from eligibility. “If a patient is in good health,” said Dr. Ford, “I would still recommend the peripheral stem cell transplant procedure.”

In-Take Session
Once approved for the procedure, the next step is the Intake Session. The Intake Session is required for both regular and bloodless peripheral stem cell transplants. During the session, the patient is evaluated by Dr. Ford and the Stem Cell Transplant team. In addition to the medical evaluation, patients and their families have an opportunity to meet the team, ask questions, and receive additional information about peripheral stem cell transplant.

The peripheral stem cell transplant process takes approximately two weeks. The following is a brief summary of what happens during that time:

Week One
The first week begins with an outpatient process called mobilization. The stem cells are mobilized by giving injections of medications that stimulate the bone marrow to produce large numbers of stem cells. This is followed by stem cell collection in which a catheter is placed in the patient’s vein, blood is circulated through a machine, which collects the stem cells and sends the blood back into the body. This is done for four to six hours a day for three days, though the length of time depends on the patient’s height and weight. Afterwards, the stem cells are frozen in liquid nitrogen, and stored with the American Red Cross until they are needed.

Week Two
During the second week, the patient is treated with high-dose chemotherapy. Following treatment, the stem cells are returned intravenously back into the body. The cells generally take about 2-3 days to settle back into the bone marrow. Within two weeks, the cells settle, multiply, mature, and are released into the body as red blood cells, white blood cells and platelets. This brief time period is also the most difficult for patients. As the hemoglobin count drops about five points, the potential to develop anemia is at its highest.

According to Dr. Ford, patients generally experience significant progress after two weeks, and fully recover within three months. While the procedure can be exhaustive, the advantages of the bloodless approach may include a faster recovery time, shorter hospital stay, reduced blood loss, and elimination of the risk of blood contamination.

Follow-up
For patients and their families considering this treatment option, the Joan Karnell Cancer Center offers stem cell procedure reunions throughout the year. The purpose of the reunions is to bring together prospective and former stem cell patients.

“It really is a team approach,” said Helen Grosky, LSW, MSS, a social worker with the Joan Karnell Cancer Center. “Patients considering this treatment are encouraged by those who have previously been through the procedure.” If a patient does undergo this treatment, Grosky adds that the Cancer Center provides post-treatment support as well.

Today, the patient that Dr. Ford treated in 1996 has made a full recovery and is living a comfortable life. Since the initial procedure, Dr. Ford has treated more than 30 patients with cancer with the bloodless approach. In addition, Pennsylvania Hospital continues to be one of the few institutions in the country to successfully treat patients with high dose chemotherapy followed by peripheral stem cell transplant without the use of blood products.

For more information about the bloodless stem cell transplant program at Pennsylvania Hospital, call 1-800-789-PENN (7366). You can also request an appointment online.

 


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