Your stem cell transplant consultation: Questions to ask

Your doctor may recommend that you undergo a stem cell transplant if you’ve been diagnosed
with a blood cancer, such as leukemia, lymphoma or multiple myeloma, or a bone marrow failure
syndrome like myelodysplastic syndrome or aplastic anemia. A
stem cell transplant replaces blood cells that have been damaged by
cancer and chemotherapy with healthy cells.

Before you move forward with a stem cell transplant, you’ll need to
consult with a transplant doctor. We talked with Borje S. Andersson, M.D., Ph.D., about the best
questions to ask to ensure that you feel comfortable with your
treatment plan.

What type of stem cell transplant are you recommending for me?

There are several types of stem cell transplants, and the type you
receive will help determine what’s needed from you prior to the
transfusion as well as what to expect with your recovery. All stem
cell transplants fall into two categories: autologous stem cell transplants, which use the
patient’s own cells, and allogenic stem cell transplants, which use cells
from a donor.

How will you find a donor for me?

We look through your family first: siblings, parents and children.
Come prepared to discuss their medical histories. Mention things like
cancer, heart problems, heavy smoking — anything that’s an alternative lifestyle.

If a related donor isn’t a possibility, there are other options,
such as an umbilical cord blood transplant or finding an unrelated
donor through Be The Match®, operated by the National Marrow Donor Program®.

Will I need other types of treatment?

A stem cell transplant is part of a treatment plan. Before the
transplant, you’ll receive chemotherapy to kill the cancer, or in some
cases, the defective bone marrow. When the new cells are transfused
into your body, they will assist in killing any remaining cancer and
replenish your body with healthy cells.

Some patients also receive low-dose chemotherapy as a maintenance
treatment after the transplant. For instance, the majority of myeloma
patients will be put on some sort of maintenance treatment that can go
on for years. Patients with Hodgkin’s and non-Hodgkin’s lymphomas also may receive follow-up
treatment — most commonly radiation.

What are the risks associated with a stem cell transplant?

Stem cell transplants successfully put many cancer patients into
remission, but as with any procedure, it’s important to talk to your
doctor about the risks, some of which are life-threatening. Risks
include side effects from the pre-transplant chemotherapy,
graft-versus-host disease and infections.

Ask about the possibility of treatment-related death and what steps
will be taken to lower your risk of complications.

What is graft-versus-host disease?

When receiving an allogeneic transplant, a patient’s cells may
attack the donor cells after recognizing them as foreign. This is
called graft-versus-host disease. Symptoms can be mild, such as a rash
or loss of appetite, or severe, such as diarrhea or jaundice.
Graft-versus-host disease can be life-threatening, but early detection
and intervention can reduce the risk of long-term effects. Patients
should be familiar with the signs so that they can seek care quickly.
To lower the risk, patients are given immune-suppressive medications.

How long will I be in the hospital for my stem cell transplant?

You should plan on being in the hospital for four to six weeks.
MD Anderson offers ambulatory treatment,
so after you’re discharged, you’ll stay within a 5-mile radius of the
hospital for the first 100 days after your transplant for close
monitoring. This allows us to address any complications quickly. In
some cases, the window from when a patient has a fever to when it’s a
life-threating infection can be as short as just 30 minutes.

That’s also where a caregiver comes in. Your
caregiver provides moral support and needs to be able to help the
patient get back to the hospital, if needed. It may just be a phone
call to 9-1-1, but that’s important and can be life-saving.

What will my life look like after I leave the hospital?

Although you may feel normal and your blood counts are normalizing,
your immune system is still weak after a stem cell transplant. Six
months to a year after the transplant, you’ll receive immunizations
like an infant because your entire immunity has been reset. And you’ll
need to be cautious about exposing yourself to germs. For example,
exercise caution around kids, don’t garden in soil and be careful in
crowded areas like movies theaters or restaurants.

Asking questions is one of the best ways to involve yourself in the
decision-making process and enhance your quality of care. To make sure
you get all of your questions answered, write down your questions in
advance and take them to your consultation. It’s also a good idea to
bring a friend or family member along to take notes. That way, you can
absorb the information you need to make the best decision for you.

Request an appointment at MD Anderson online or by
calling 1-877-632-6789.