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Transplants - Questions and AnswersBone marrow is the spongy tissue that is
found in the center of bones. The bone marrow's main function is to make the
blood cells that circulate in your body. These blood cells develop from immature
cells called stem cells that mostly live in the bone marrow, but also circulate
in the blood in small numbers.
Bone marrow can be used for the purpose of giving a person healthy stem cells
that grow into blood cells or peripheral blood can be used to give a person
healthy stem cells. The first successful bone marrow transplant was performed
in 1968. It was not until 1984 and 1986 that successful peripheral blood stem
cell transplants (PBSCTs) were performed.
The most immature cells that form the cells in the blood are the stem cells.
They are found in the bone marrow and it is here that they produce blood cells.
Stem cells are said to be "pluripotent" because they have the ability
to develop, or evolve into different types of blood cells needed by the body.
Some stem cells also circulate in the bloodstream and are called peripheral
blood stem cells (PBSCs). PBSCs are found in much smaller quantities in the
circulating blood than in the bone marrow. The 3 main types of blood cells (RBCs,
WBCs and platelets) are all made from stem cells.
The RBCs (erythrocytes) are important for carrying oxygen from the lungs to
the body's tissues and then transporting carbon dioxide from the body's tissues
back to the lungs to be exhaled. The hematocrit indicates the percentage of
your blood that is made up of RBCs. The normal range is about 35-50%. When the
hematocrit is below about 35% a person develops a condition called anemia. This
will often make the person appear pale and tire easily.
The WBCs or leukocytes fight infections. They help fight off bacteria, viruses
and fungi that may cause infection. There are 2 main types of WBCs: neutrophils
and lymphocytes. The neutrophils are responsible for fighting infection and
the lymphocytes are responsible for immunity. When the neutrophil count gets
too low, a person has a condition called neutropenia and is at greatest risk
for infection.
The platelets (thrombocytes) help your blood to clot. The normal platelet count
is about 150,000 to 400,000. When your platelet count drops below normal you
develop a condition called thrombocytopenia, or low platelets in the blood.
When your platelet count is low you may bruise easily, bleed for a longer period
of time than normal or have nose bleeds or bleeding gums. If your platelet count
is lower than 20,000 you may bleed spontaneously (without a specific cause).
The blood cells do not enter the bloodstream until they have gone through various
stages and matured so they can function properly. Therefore, cells in these
various stages of maturity are normally found throughout the bone marrow. The
bones in the body that contain larger amounts of marrow and therefore the largest
quantities of stem cells are the iliac bones in the pelvis. The site where the
marrow is most often removed from the body for a BMT is the pelvic bone. Enough
marrow is removed in order to obtain a large quantity of healthy stem cells.
For PBSCTs, the stem cells are removed from the blood circulating throughout
the body rather than the pelvic bones.
A stem cell transplant with bone marrow or peripheral blood stem cells may be
performed when a patient's bone marrow is damaged and cannot make red blood
cells, white blood cells, and platelets that the body needs. The damage to the
bone marrow may be due either to a disease that affects the bone marrow itself
or to high doses of cancer treatment.SCT is a type of intravenous transfusion
that replaces diseased or damaged stem cells with new, functioning stem cells.
In patients with diseases that affect the bone marrow directly, such as leukemia,
aplastic anemia, and some diseases of the immune system, the stem cells in the
bone marrow malfunction and produce too few blood cells (in the case of a disease
such as leukemia). These abnormal stem cells crowd out the normal cells and
interfere with their production which causes the body to not have enough needed
RBCs, WBCs, and platelets. Chemotherapy or radiation therapy is used to kill
the abnormal cells and make room for the new bone marrow stem cells, and then
a SCT is done to provide the patients with new bone marrow stem cells that will
develop into healthy blood cells. SCT can also be used in the treatment of forms
of cancer that do not affect the bone marrow directly, such as lymphomas or
breast cancer. Some of these cancers do not respond well to normal doses of
chemotherapy and may be treated more effectively with high doses of chemotherapy,
radiation therapy, or both. Unfortunately, these therapies cannot distinguish
between normal cells and cancer cells, so they kill not only the cancer cells,
but many of the normal cells as well, including the cells of the bone marrow.
By providing a way to replace the bone marrow stem cells that the cancer therapy
has destroyed, SCT enables patients with cancer to receive these high doses
of cancer treatment.
There are three basic types of SCT: autologous, allogeneic, and syngeneic. The
source of the stem cells used determines the type of transplant.In an autologous
SCT, you are your own donor. Your stem cells are taken from you through a process
called "harvesting," frozen until needed, and then given back to you
(transplanted) after you have received high doses of chemotherapy, radiation
therapy, or both. Before it is given back to you, the stem cells may be treated
with anticancer drugs or antibodies (called purging) to reduce the number of
cancerous cells that may be present as much as possible. This can be done with
bone marrow or peripheral blood. Autologous SCT is the most common type of SCT.
It is performed twice as often as allogeneic or syngeneic SCT. Because the donor
and the recipient are the same person in autologous SCT, there are fewer complications
and side effects than with allogeneic transplants.
In allogeneic SCT, a donor supplies new, healthy stem cells. The best donor
for you is someone whose tissue type matches yours as closely as possible. Usually
that person is a member of your family such as a brother or sister. But for
patients who don't have a family member who "matches" with you, it
is often possible to find a donor in the general population, through a national
registry.
In a syngeneic SCT, the donor is an identical twin. This is often an ideal situation.
The donor and recipient will have identical tissue types. In reality, though,
such transplants are rare (less than 1%), because relatively few people have
identical twins.
This is the original method for performing stem cell transplants because the
bone marrow has such a rich supply of them. The donor is given general anesthesia
and then multiple punctures are made in their pelvic bone to remove the marrow.
Their only side effect, aside from undergoing general anesthesia, is that they
are sore for a few days afterward. The marrow is stored in a special chemical
solution in bags and then frozen in liquid nitrogen. When it is time to transfuse
the frozen marrow, it is thawed and then transfused just like a blood transfusion.
The stem cells head for the bone marrow where they begin to grow and produce
blood cells. It takes at least two weeks for the new blood cells to begin appearing.
A peripheral blood stem cell transplant (PBSCT) involves the removal of stem
cells from the circulating blood prior to treatment with larger doses of chemotherapy
or radiation. This is a fairly painless procedure that is like donating blood,
but takes much longer. The cells are given back to the patient after treatment.
Generally, patients would not be able to tolerate these high doses of cancer
treatment because the toxicity to the bone marrow would be too great. However,
large doses of cancer treatment can be given if they are followed by an infusion
of healthy stem cells to promote recovery of the bone marrow. The infusion of
stem cells is similar to the infusion of bone marrow.
There are two main reasons for performing PBSCTs. A transplant may be
performed 1) when an individual's stem cells (cells that make red blood cells,
white blood cells and platelets) are damaged or diseased, or 2) when an individual
is given high dose chemotherapy and/or radiation in order to kill all possible
cancer cells. When this is done, the doses are so high that the healthy stem
cells or marrow cells are also destroyed and must be replaced. In either case
PBSCT involves a type of transfusion of healthy new stem/marrow cells.
Originally all stem cell transplants performed were BMTs. Now PBSCTs are used
with increasing frequency instead of BMT. Certain individuals may need a PBSCT
rather than BMT if they: 1) cannot receive autologous BMT because their marrow
has a low number of cells from prior chemotherapy or radiation to the pelvic
bones, 2) have cancer that has spread (metastatic disease) to the marrow, or
3) have conditions that would not permit general anesthesia that is used when
removing marrow cells for a BMT. The purpose of either method is the same, that
is to give the person healthy stem cells that will mature to healthy blood cells.
Also, doctors are often able to harvest more stem cells from peripheral blood
than bone marrow. This is because the donors are given drugs that stimulate
the body to release stem cells into the
blood. Another advantage for PBSCT is that the recipient's blood counts recover
faster than with BMT.
The transplant process is similar whether an individual receives an autologous,
allogeneic, or syngeneic transplant and whether the individual receives cells
from the bone marrow or the peripheral blood. There are several stages in the
transplant process: evaluation for eligibility, admission to the inpatient or
outpatient unit, conditioning treatment, infusion of the stem cells, recovery,
discharge, and rehabilitation.
The first stage involves an evaluation to determine if the individual is eligible
for a transplant and the individual's decision to have the transplant. This
first stage involves a thorough evaluation. The person will have several different
medical tests that might include:
-HLA tissue typing
-bone marrow biopsy and aspiration
-appropriate scans
-heart tests such as electrocardiogram (ECG), cardiac
-echocardiogram
-complete history and physical examination by their doctor
-lung studies such as a chest x-ray and pulmonary function tests
-appropriate consultations with other members of the transplant
-health professional team (e.g., psychosocial, dental)
-blood tests such as complete blood count (CBC), blood chemistries,
-screening for viruses, tests for hepatitis, herpes, and HIV antibody
During this stage a person may also have a central venous catheter (CVC) placed
in a large vein to help draw blood samples and infuse medications. For individuals
receiving an autologous BMT or PBSCT the stem cells will be harvested from the
bone marrow or removed from the peripheral blood during this stage and frozen
until given back to the patient.
Some people tolerate a transplant better if they are in the early stages of
disease and are younger. Some centers have an age limit (around 50) beyond which
patients are not eligible for a allogeneic transplant and 60-65 for autologous
transplant. Individuals also may not be eligible if they have major health problems
(heart, lung or kidney disease).
The procedure for collecting stem cells from the bone marrow (usually from the
iliac crest bones) is the same whether the source is the recipient/patient or
a donor. The donor usually enters the hospital on the day before the BMT is
scheduled. The cells are obtained during a procedure called a bone marrow harvest.
This is done under sterile conditions in an operating room. General or spinal
anesthesia is used while the marrow cells are removed from the back iliac crests
using a large bore needle. The amount removed will depend on the donor's weight.
About 10-15 ml/kg of body weight are collected. This is often a total volume
of about 500-1,000ml. It is important to collect enough cells for the transplant
to be done. The procedure takes about an hour or two to collect all of the bone
marrow cells needed.
After the cells are collected they are placed in a special tissue culture medium
and filtered through a series of fine mesh screens to prevent any bone or fat
particles from being given back to the recipient. For an allogeneic or syngeneic
transplant the bone marrow cells are processed and placed in bags and given
back to the recipient within several hours of removing the cells for the donor.
The cells are given intravenously (into a vein) or infused. For an autologous
transplant the bone marrow cells are collected during a period of remission
possibly purged or cleansed of residual malignant cells, and then cryopreserved
(frozen) and reinfused at a later date. At least 90% of the cells keep their
ability to function when frozen and the cells may be successfully stored for
many years.
With an allogeneic or syngeneic transplant, the donor usually enters the hospital
on the day before the patient is to receive the cells. On the morning of the
day of the infusion of the cells, the donor is taken to the operating room and
the bone marrow is removed. Only about 10% of the donor's entire bone marrow
cells are taken so these cells will regrow within a few weeks. After the harvest
is completed, the donor is sent to the recovery room until the anesthesia wears
off. The donor then returns to their hospital room and is checked frequently
by nurses until fully alert and able to eat solid food. The donor often can
leave the hospital in a few hours or the next morning. The donor may experience
some soreness in the hip area for a few days. Usually, this is relieved by taking
over the counter acetaminophen or non-steroidal antiinflammatories. The doctor
might recommend that thedonor take iron supplements until his supply of RBCs
replenishes itself. The risks of being a donor are minimal and the possibility
of serious complications is very low. If problems do occur, they are usually
related to general anesthesia and include nausea, possibly sore throat. There
is no cost to the donor for the bone marrow harvest or hospitalization. The
cost is usually assumed by the recipient's insurance company. Most donors feel
the opportunity to give another individual a second chance at life is rewarding.
PBSCs are 10-100 times less concentrated than marrow cells. Therefore, more
volume is needed to collect an appropriate number of cells for engraftment.
The process used to obtain PBSCs is called apheresis. This is done using a machine
that separates the different types of blood cells so only the part of the blood
containing most of the stem cells is removed and other cells are returned to
the patient. The procedure is done as an outpatient. Before starting apheresis
the person might receive colony stimulating factors that stimulate the production
of more stem cells and their release into the peripheral blood system. Peripheral
stem cells are collected through a catheter placed in a large vein and separated
by using the cell separator machine. The RBCs, platelets and plasma are returned
to the individual and the stem cells are retained. Each apheresis session lasts
an average of 2-4 hours. Most individuals require several sessions (2-10) over
days to weeks to collect enough stem cells for engraftment (growth of the stem
cells in the marrow and production of blood cells).Side effects caused by apheresis
can include problems with the placementof the catheter, infection in the catheter,
catheter blockage, and blood clots. Individuals may also experience tingling,
chills, and lightheadedness during the apheresis sessions.
Even though the cells collected by harvest or apheresis are obtained while the
individual is in remission, some microscopic malignant cells may remain. Thus,
some transplant centers "purge" the stem cells to remove any remaining
malignant cells before they are given to the recipient. The process of purging
is controversial. The disadvantage is that it also loses some stem cells. This
delays the recovery of normal blood production in the patient. They will be
without WBCs or platelets for a longer period of time. This may result in the
recipient being at a greater risk for infection or bleeding problems.
Whether the patient will receive the transplant in the hospital or as an outpatient
depends on the specific hospital's program. If an individual is to be admitted
to the hospital, they are often admitted one day prior to starting the conditioning
treatment. During this time the members of the transplant team make sure that
the individual and family fully understand the transplant process and have given
permission to have the transplant. This is important because once the conditioning
treatment of chemotherapy and/or radiation is given the individual is not able
to discontinue treatment without very serious risk. When admitted to the hospital
the individual will be protected from exposure to infection usually by being
in a room that is specially prepared to isolate the person. The room may be
one with a: 1) high efficiency particulate air (HEPA) filter and positive air
pressure system used in a conventional hospital room or, 2) laminar air flow
(LAF) room equipped with HEPA filters in which a protective barrier separates
the sterile patient zone from the outer zone.
This stage of the transplant may be overwhelming for recipients and their families.
The recipient will have a team of health professionals available to address
physical, psychosocial, and rehabilitation needs. All questions should be asked
and answered thoroughly so individuals and families understand the process.
Several words are used to describe this next stage: conditioning, preparation
and ablation. The conditioning treatment is the chemotherapy and/or radiation
given in order to: 1) prepare room for the transplanted cells to engraft, 2)
suppress the recipient's immune system in order to accept the allogeneic cells,
or 3) eliminate malignant disease. No one conditioning treatment is used for
every transplant performed. Conditioning treatments are made up of combinations
of various chemotherapy and/or radiation. The specific combinations of chemotherapy
drugs and the decision whether radiation is needed depends on the disease, type
of transplant, and prior chemotherapy or radiation received by the individual.
The chemotherapy will be given through the central venous catheter (CVC) or
by mouth. If radiation is given, it is usually given to the entire body and
is called total body irradiation (TBI) to decrease the patient's immune system
or to prepare space for the cells to engraft. TBI is given in divided doses
over several days for a total dose of 500 to 1,600 cGY. This can be a very uncomfortable
procedure. The side effects of the chemotherapy can be very debilitating and
painful. Many patients take several months to recover back to full strength.
You should discuss this thoroughly with your doctor and if you want, with people
who have undergone the procedure.
Once the conditioning treatment is completed the individual will be given 1-2
days of rest prior to receiving the new healthy cells back. The day the cells
are infused is called "Day 0." All the days prior to Day 0 are considered
minus days (e.g. the individual may have been admitted on Day -6, received chemotherapy
and radiation on Days -5 to -2, then had rest days on Day -2 and Day -1). Every
day after the infusion of cells is considered a positive day (e.g., Day +1,
Day +2). The actual infusion of the cells is similar to other blood transfusions.
Over the years, since 1891, various routes have been used to infuse the cells
back into the patient, but today the cells are usually given back intravenously
(IV) through the CVC over several hours. Once the cells pass into the blood
stream they travel through the lung and to the bone marrow and reestablish themselves
in 1 to 4 weeks. In 1 to 4 weeks the recipient will begin to have an increase
in WBC, RBC and platelet counts. This is an indication of engraftment, or that
the stem cells are working properly. It may take months to years, however, for
the entire immune
system to recover. For an autologous transplant, the recipient's cells are brought
from the in several bags and thawed by warming them in a water bath at 37oC.
Once the cells are thawed, they are infused immediately. For allogeneic or syngeneic
transplants the cells are taken from the donor in the operating room and then
processed in the laboratory. Once the cells are ready to be infused, they are
brought to the recipient's room and given by the CVC. This stage of the transplant
is an important stage. It is time and labor intensive and has great significance
for the recipient and family. This is considered by many recipients as a day
of rebirth or chance at a second life. Recipients may declare this date their
"birthday." (In future years they celebrate this day as they would
the actual day of their birth.) Side effects of the infusion are rare and often
mild. The preserving agent used when freezing cells is called dimethylsulphoxide
(DMSO). This agent can cause patients to experience an immediate garlic or creamed
corn taste. Sucking on hard candies or sipping flavored beverages during and
after the infusion may help. Unfortunately, the taste may persist for 24 hours
and cause temporary nausea and vomiting. Patients undergoing allogeneic or syngeneic
transplants do not experience this problem as the cells were not mixed with
DMSO and frozen. Other side effects may include:
-Fever, chills
-Shortness of breath
-Tightness in the chest
-Low blood pressure
-Coughing
-Chest pain
-Decreased urine output
-Malaise
Most PBC infusions are autologous and follow the same procedure as for
infusion of marrow cells. The main difference is the volume of PBSCs
needed for infusion. A recipient may have 4 to 32 bags of PBC cells infused,
while a BMT recipient may only have 2 to 8 bags infused. In some centers, transplants
are now being done by combining some bags of marrow cells with some bags of
PBSCs. The major side effects with the PBSCs include giving the body too much
fluid, which could result in collection of fluid in the lungs, and temporary
kidney problems.
The next stage is the recovery stage. This begins the day after the infusion
of cells (Day +1). During this time the individual and family wait for the cells
that have been infused to graft or "take" and begin to multiply and
produce normal blood counts. The length of this stage will vary depending upon
the patient and type of transplant. It often takes 2-6 weeks. During these first
few weeks the individual will have low WBCs, low RBCs and low platelets and
may develop some complications. Except for GVHD, which only occurs with allogeneic
transplants, the side effects from autologous and syngeneic BMT and PBSCT are
similar. Physical problems may include infections from low WBCs, stomach (gastrointestinal
problems), heart, lung, liver or kidney problems. Individuals may experience
varying levels of distress, anxiety, depression, joy or anger. Being isolated
from others contributes to the emotional adjustment after infusion.The decision
to have a transplant is a big one for any individual and family. Every part
of one's personal and professional life is disrupted. The future becomes uncertain.
The financial burden can become overwhelming. All of this may lead to a wide
range of emotions throughout the transplant process. These emotions are often
temporary, but important.
Planning for discharge will begin weeks before the individual is actually allowed
to go home. Education by the transplant team is an
important part of the discharge process. Nurses will provide information on:
precautions to take preparation of the home environment, care of the central
venous catheter, good hygiene, oral care, appropriate diet and activity and
when to call the transplant team or health care professionals. Each transplant
center has their own specific discharge criteria, but in general individuals
must be able to meet the following guidelines prior to going home:
-have no fever for 48 hours
-able to take oral medications for 48 hours
-have no nausea, vomiting or diarrhea or, if present, is controlled with medications
-have an absolute neutrophil count (ANC) of 500 to 1000/mm3
-have a hematocrit > 25 to 30%
-have a platelet count > 15,000-20,000/mm3
-have an adequate home environment and support at home
Most transplant centers allow individuals to be discharged directly to their
home, depending on its proximity to the hospital. Others choose to have patients
stay in an outpatient setting if they do not meet all of the discharge criteria,
but no longer require the intensive care of the transplant unit.
This stage is the post-discharge phase. Many patients describe this stage as
a roller coaster. Some individuals may continue to experience some physical
or psychological problems that affect their quality of life after discharge.
All recipients of transplants are closely monitored during the early rehabilitation
period. Individuals may need daily or weekly examinations in the outpatient
clinic. Laboratory tests may also be performed during these visits: blood tests,
chest x-rays, bone marrow aspirations, or lumbar punctures. Recipients may also
need to receive blood transfusions, immunoglobulin therapy, or hematopoietic
(blood forming) growth factors during the early rehabilitation stage. It is
possible for individuals to experience problems 100 days or more after the infusion
of healthy cells. These complications usually result from the chemotherapy and/or
radiation that was given. For the first year after a transplant, individuals
often suffer some physical effects. However, some effects may last longer than
one year or continue as chronic problems. These chronic problems may be physical
or psychosocial. Late complications or effects resulting from the transplant
include: Chronic GVHD (involving skin, liver, oral, vaginal or gastrointestinal
problems)* Infectious complications (bacterial, viral or fungal) Lung complications
(interstitial pneumonitis, pneumocystis carinii, cytomegalovirus, obstructive
disease) Kidney complications (radiation nephritis, kidney insufficiency) Cataracts
Memory loss, difficulty concentrating
Low thyroid function, Retardation in growth and development in children, Sexual
dysfunction (sterility, ovarian failure) Secondary malignancies, Emotional distress,
depression, body image changes, anxiety, Job discrimination, changes in relationships,
insurance, discrimination, Changes in meaning of life, feeling indebted to others,
Overwhelming fatigue Seen with allogeneic transplants
INFECTION:
The preparative regimen is given before the transplant has destroyed most of
the recipient's white blood cells. Until engraftment occurs and the new bone
marrow begins making white blood cells, usually in 2 to 6 weeks, the recipient
will be extremely susceptible to infection. The administration of hematopoietic
(blood forming) growth factors may decrease the amount of time the recipient
is most susceptible to infection. Bacterial infections are the most common type
during this early period after the transplant. The risk of infection declines
steadily following engraftment, but it will remain a potential problem for some
time; most patients' immune systems do not function at full efficiency for 6
months to a year after transplant, and often longer for patients with GVHD.
The early period is the most critical, so this is the time when the recipient
will be monitored closely for signs of infection and when protective isolation
precautions will be followed. Anyone who enters the recipient's room, whether
family members or medical professionals, will wash their hands thoroughly (since
hands are primary carriers of infection) and will wear gowns, gloves, and masks.
Flowers and plants, which can harbor bacteria and fungi, will not be permitted
in the room while the recipient's WBC is low. For the same reason, fresh fruits
and vegetables will be eliminated from the diet, and food will have to be well
cooked. Other dietary restrictions will probably be started to reduce the chance
of infection. Fever is one of the first signs of infection. Most patients develop
fever, despite the most painstaking precautions. If this occurs, the recipient
will be given a combination of broad-spectrum intravenous antibiotics to help
fight the infection.
BLEEDING:
The recipient is at risk for bleeding because the preparative
regimen has destroyed most of the body's supply of platelets, the blood cells
that enable the blood to clot. A low platelet count will persist for at least
3 to 4 weeks after the transplant. Nosebleeds, bleeding gums, bruising, or bleeding
at other sites may occur. If the platelet count falls below 20,000, a transfusion
of platelets and red blood cells may be given.
INTERSTITIAL PNEUMONIA:
Interstitial pneumonia is a non-bacterial, non-fungal form of pneumonia that
infiltrates the interstitial spaces of the lungs. It may be caused by a virus
or by radiation therapy or chemotherapy, and it is most common in the first
100 days after BMT. The recipient will have regular chest x-rays while in the
hospital and will be watched closely by the BMT team for any signs of pneumonia.
GRAFT-VERSUS-HOST-DISEASE (GVHD):
GVHD is a complication that occurs only with allogeneic transplants; it does
not affect autologous BMT recipients, and only rarely does it occur in syngeneic
BMT recipients. While as many as 30% to 50% of allogeneic BMT recipients develop
GVHD, most cases are mild, and the majority of patients come through the disease
with no long-term effects. GVHD can occur when the recipient's new bone marrow
engrafts and the donor's cells (the graft) recognize the recipient's body (the
host) as foreign. The graft may attack certain organs, impairing their ability
to function and increasing susceptibility to infection. The organs usually affected
are the skin, gastrointenstinal (GI) tract, and liver. There are two kinds of
GVHD: acute and chronic. Acute GVHD can occur from 10 to 70 days after BMT;
the average time of onset is around day 25. Chronic GVHD can occur anywhere
from 100 to 400 days after BMT. The earliest sign is usually a skin rash that
appears on the palms of the hands or the soles of the feet; the rash can then
spread to involve all of the skin. The rash usually feels itchy and dry, and
in severe cases the skin may peel as it would after a bad sunburn. A fever may
also develop. Other symptoms of GVHD include decreased appetite, diarrhea, abdominal
cramps, weight loss,jaundice, an enlarged liver, a bloated abdomen, pain in
the upper right part of the abdomen, and increased levels of liver enzymes in
the blood. Chronic GVHD is usually manifested by a red, itchy rash; a tight
feeling to the skin; jaundice; elevated levels of liver enzymes in the blood;
dry, burning eyes; dryness or sores in the mouth; burning sensations when one
eats acidic foods; and bacterial infections. GVHD is treated with medications
that suppress the T-cells of the immune system. It may be possible to decrease
the risk of GVHD by preventing infection to the extent possible, giving irradiated
blood products when transfusions are necessary, and depleting the donor marrow
of some T-cells before infusing it.
GRAFT FAILURE:
Graft failure occurs when the body is unable to accept the new bone marrow (the
graft). The period of risk for graft failure lasts for 2 to 4 months following
transplant. The administration of hematopoietic growth factors may serve to
speed engraftment, thereby decreasing the risk of graft failure. The risk of
graft failure varies with different types of transplants; it is more common
in patients whose donor marrow is not well matched and in patients who receive
marrow that has been depleted of T-cells. In general, graft failure is a relatively
rare occurrence.
Caitlin Raymond International Registry
Telephone: 1-800-726-2824
Internet: www.crir.org
Blood and Marrow Transplant Newsletter
Telephone: 1-888-597-7674
Internet: www.bmtnews.org
National Bone Marrow Transplant Link (NBMT Link)
Telephone : 1-800-546-5268
Internet:www.comnet.org/nbmtlink
National Marrow Donor Program
Telephone: 1-800-526-7809 (patients) or 1-800-627-7692 (for donor
information)
Internet: www.marrow.org
Buchsel PC, Yarbro CH. (eds.). 1993). Oncology Nursing in the Ambulatory
Setting: Issues and Models of Care. Boston, Ma: Jones and Bartlett.
Buchsel P.C. (1993). Bone marrow transplantation. In Groenwald SL., Frogge
MH, Goodman M. et al (eds.). Cancer Nursing: Principles and Practice (3rd
ed.). Boston, Ma: Jones and Bartlett.
Buchsel PC. (1986). Long-term complications of allogeneic bone marrow
transplantation: Nursing Implications. Oncology Nursing Forum, 13: 61-70.
Deeg HJ, Klingemann HG, Phillips GL, and van Zant G. (Eds.) (1999) A
Guide To Blood and Marrow Transplantation. 3rd ed. Berlin: Springer.
King CR. (in press). New Frontiers of Chemotherapy. In Burke MB, Wilkes
GM, Ingwersen KC, Bean CK, and Berg D (eds.). Cancer Chemotherapy 3rd
ed. Boston, Ma: Jones and Bartlett.
King CT. (1995). Peripheral Stem Cell Transplantation: Past, present and
future. In Buchsel PC, and Whedon MB (eds). Bone Marrow Transplantation:
Administrative and Clinical Strategies. Boston, Ma. Jones and Bartlett.
King CR. (1993). Bone Marrow Transplantation Clinical Background Manual.
Paramus, Nj: Roche Professional Service Centers.
O'Connell AS, Schmit-Pokorny K. (1997). Blood and marrow stem cell
transplantation: Indications, procedure, process. In Whedon MB, Wujcik D
(eds.): Blood and Marrow Stem Cell Transplantation: Principles, Practice,
and Nursing Insights, 2nd ed. Boston, Ma: Jones & Bartlett.
Santos GW. (1983). History of bone marrow transplantation. Clinical
Haematology 12 (3), 611-639.
Whedon MB, Wujcik D. (eds.)(1997). Blood and Marrow Stem Cell
Transplantation: Principles, Practice, and Nursing Insights, 2nd ed. Boston,
Ma: Jones & Bartlett.
