An Introduction to Marrow & Cord Blood Transplant

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					NATIONAL MARROW DONOR PROGRAM®
Creating Connections. Saving Lives.™

An Introduction to Marrow & Cord Blood Transplant

March 12, 2008

Today’s Agenda
 Betsy, Transplant Survivor  Alanna Kurosky, Nurse Practioner at the Karmanos Cancer Center in Detroit Michigan, Blood and Marrow Transplant

 Office of Patient Advocacy Case Managers
 Kay, Caregiver of an Adult Transplant Survivor  Question and answer time with speakers

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Transplant Survivor Experience

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Basics of Unrelated Marrow and Cord Blood Transplants
 Stem cells are blood-forming cells used in transplant
– Marrow – Peripheral blood stem cells (PBSC) – Cord blood

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DONOR TYPE OF TRANSPLANT
Cell Source Self Genetically Matched Sibling Type of Transplant Autologous Related Allogeneic GENETICALLY MATCHED UNRELATED DONOR UNRELATED ALLOGENEIC

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Matching by HLA
 Human Leukocyte Antigens (HLA) are proteins found on the surface of most cells in the body, but are found in greatest numbers on white blood cells.

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HLA Typing
 HLA typing of donor and patient is done to help find a stem cell match  There are thousands of different types of HLA proteins  Each person has a small unique set inherited from their parents

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HLA Inheritance
Mother A
1 3 5 2 4 6

Father A B C DR Child 2 Child 3 A B C DR
2 4 6 8 9 11 13 15 9 11 13 10 12 14

B
C DR

7

8

15

16

Child 1 A B C DR
1 3 5 7 9 11 13 15

Child 4 A B C DR
2 4 6 8 10 12 14 16

A B C DR

1 3 5 7

10 12 14 16

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What Do HLA Antigens Do?
 HLA helps the immune system recognize us as being different from foreign substances that may enter the body.  If donor stem cells are not the same HLA type as the recipient they will recognize the recipient as being different and attack. This response is called graft versus host disease (GVHD).
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How an Unrelated Donor is Found
 Your transplant center is responsible for searching for a donor.  The NMDP Registry
– Pool of donors – Domestic and International donors

 Search process
– Preliminary Search – Formal Search
• Adult donor process • Cord Blood process

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Benefits and Potential Risks of Transplant
Possible complications  Treatment related fatality and illness  Graft vs Host Disease (GVHD)  Infections  Mucositis (irritation of lining of the mouth & throat)  Nausea & Vomiting  Relapse of original cancer Benefits of BMT

 No longer have the disease - REMISSION
 Extension of a good quality of life

 Graft vs Leukemia Effect

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The Preparative Regimen
 Radiation &/or chemotherapy given prior to transplant that destroy diseased cells and healthy stem cells.  Stem cells given after the preparative regimen replace the destroyed stem cells and provide the recipient with a new immune system.  Given over 2-10 days and usually hospitalized.  Medications to prevent “GVHD” are started.

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High Dose Transplant
 Higher doses of radiation/chemo administered with goal of killing ALL of the patient’s stem cells and diseased cells.  Used in patient’s with more rapidly growing cancers.

 Usually experience more side-effects.
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Reduced Intensity or “Mini” Transplant
 Lower doses of radiation/chemo are given that kill SOME of the patient’s stem cells and diseased cells.  Used in patients with slower growing cancers or who are less likely to tolerate the side effects of a high dose transplant.
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Day of Transplant
 Stem cells from marrow or peripheral blood are collected from donor the day before and/or the day of transplant.  Transported to patient and administered like a blood transfusion.  Cord blood units are shipped to transplant center and stored before start of preparative regimen.  Side effects are the same as a blood transfusion and may include fever, chills and rash.
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Recovery – Early Days after Transplant
 14-28 days of extreme immune suppression:
– Very low white blood cell, red blood cell & platelet counts

 At risk for life threatening infections, bleeding, and organ damage from the preparative regimen

 Antibiotics given to prevent & treat infection
 Blood & platelet transfusions given as needed  Closely monitored for organ damage and treated as needed
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Engraftment
 Term used to refer to growth of new stem cells within the bone marrow and the appearance of white blood cells, red blood cells and platelets in the bloodstream.

 Occurs 14-28 days after transplant
 Risk for infection and bleeding decreases following engraftment

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Getting Discharged
 You will be discharged from the hospital when:
– You’ve engrafted –Absolute Neutrophil Count (ANC)>500 – No active infection – No active Graft Versus Host Disease (GVHD) – Able to take foods and meds by mouth

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Your 1st 100 Days Post-Transplant
 Closely monitored for complications such as “GVHD” and infection.  Frequent clinic visits with possible readmission to the hospital for treatment of complications  Restriction of activities

 Avoid crowds, use mask when in public places
 Catheter care  Need caregiver for transportation, shopping, cooking  Unable to take care of small children or pets
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Moving Forward
 Transitioning your care

 Survivorship
 Finding Support
 Your transplant center

 NMDP newsletter “Living Now”
 Websites: www.marrow.org; www.nbmtlink.org; www.bmtinfonet.org; www.thewellnesscommunity.org

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How the Office of Patient Advocacy Can Help You
– One to one support – Education – Resources – Materials – Financial education and assistance

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Financial and Insurance Resources
 Mapping the Maze
– Questions to ask insurance provider and transplant center staff

 Related fact sheets
– Financial and Insurance Matters – Rights and Benefits

 Patient Assistance Program
– Search Assistance Fund – Transplant Support Assistance Fund

 Help with insurance appeals
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Tools and Resources
 Financial planning tool: www.marrow.org/planahead  Searchable resource database: www.marrow.org/resources  Materials:

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Caregiver Experience

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Questions?

Contact an OPA Case Manager
Phone: 1-888-999-6743 Email: patientinfo@nmdp.org Website: www.marrow.org/patient

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