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Stem Cell Transplant:
Introduction and Overview
Volumes have been written about the treatment of breast cancer. The amount of information could fill a library. This booklet, while written for breast cancer patients, families, and friends, focuses on just one procedure: stem cell transplant. Breast cancer is the number one diagnosis for which stem cell transplant is performed today. Due to the dramatic increase in the number of breast cancer patients having this procedure, a patient-friendly booklet had to be written.
Currently, only a limited number of the 180,000 women diagnosed yearly with breast cancer will need to consider the option of a stem cell transplant. If your physician or medical team has suggested a stem cell transplant to you or someone you know, this booklet will be a valuable resource and companion.
As a patient, you want to learn as much as possible in order to make the best treatment decision. The purpose of this booklet is first and foremost to educate. Because the subject of stem cell transplant can be complex and difficult to understand, the second goal of the booklet is to clarify. Coping with a difficult diagnosis and the anxiety of making major life decisions, breast cancer patients look for hope and encouragement. Thus, the third goal of the booklet is to provide support. There are many resources, including the Internet, which offer help to the breast cancer patient considering stem cell transplant. Therefore, the booklet's final goal is to identify additional resources. Stem cell transplant for breast cancer is a procedure that is evolving. Much has been learned. Much is yet to be discovered. Without question, there is still debate on the subject. While the procedure is not a simple solution, it does offer a promising approach. To insure that you have the most current information, this Web site will provide updates and new developments.
Use this booklet as a guide to enhance the recommendations of your physician and health care team. This booklet is not a substitute for medical advice or an endorsement for a particular procedure. Whichever path you ultimately choose, we hope this booklet makes the way easier.
Underlined words may found in the Glossary.
You may be reading this booklet having experienced a recent breast cancer diagnosis. The shock of this news may still be difficult and fresh. Or you may be someone who has lived with breast cancer for years, coping with an unexpected recurrence of the disease. Your physician might have introduced the unfamiliar term, stem cell transplant, to you. Or you may have read about it on your own. How you view the prospect of a stem cell transplant may be influenced by factors such as your age, general health, marital status, or financial circumstances. For you and all other women in this situation, there are questions that require answers. And while your own "point of entry" in reading this booklet is important, the information is meant to be relevant to every woman considering a stem cell transplant for breast cancer.
Who qualifies for this procedure? Stem cell transplant is often suggested to women with advanced breast cancer that has spread to other areas (metastatic disease). Stem cell transplant is also recommended to some women with early breast cancer who are at high risk for relapse, such as those with many positive lymph nodes under their arm (axillary nodes), and to some women with locally advanced cancer, such as inflammatory breast cancer.
To learn more about stem cell transplant you must have some general understanding of bone marrow transplant (BMT). Nearly 100 years ago physicians began to experiment with bone marrow transplant. It was only in the past 30 years that real advances were made.
Bone marrow is the spongy tissue found in the cavities of the body’s bones. It contains special cells called stem cells from which all blood cells are produced. Each type of blood cell begins its life as a stem cell. The stem cells divide and form the different cells that make up your blood and immune system. These include:
You can see that any change in the function of the bone marrow would have powerful effects within the body. BMT is used in some situations to replace bone marrow that no longer works normally.
Simply explained, a BMT involves removing bone marrow cells from the bone with a needle and then giving it to a patient through a transfusion. Once the new marrow cells enter the bloodstream, they travel to the patient’s bones and begin to reproduce. Transplant procedures vary according to the disease being treated. Diseases such as leukemia, lymphoma, multiple myeloma, aplastic anemia, and various blood disorders are often treated with BMT. The steps involved in a BMT may differ slightly from one treatment center to another. Highly trained medical staff from centers specializing in bone marrow transplant handle the procedure.
There are several types of BMTs. They are categorized according to the source of the stem cells.
The principles used in a bone marrow transplant have been adapted for use with breast cancer patients. Women having a stem cell transplant for breast cancer are, in fact, having a type of autologous BMT. Currently most transplants done for breast cancer are autologous, except for a few centers where allogeneic transplants are being done as an experimental procedure.
A stem cell transplant is the same as a bone marrow transplant except that stem cells are collected from the circulating blood instead of the bone marrow. Instead of inserting a needle directly into the bone marrow to obtain cells, drugs called cytokines or growth factors are given to "mobilize" stem cells; that is, to move them out of the bone marrow and into the bloodstream. They can then be collected using an intravenous catheter similar to those used for collecting blood. These cells are sometimes called peripheral blood stem cells.
The source of the stem cells and how they are collected are the main difference between peripheral blood stem cell transplant and bone marrow transplant. Peripheral blood stem cells are given to you as a transfusion and, like bone marrow cells, are able to make red blood cells, white blood cells, and platelets. Stem cells are collected from you and then frozen until the time of transplant. Just before transplant you are given high doses of chemotherapy and/or radiation. This kills cancer cells in your system. It also damages your bone marrow’s ability to make new blood cells. Your frozen stem cells are then thawed and given back to you. This is done by a painless transfusion and may be referred to as a "rescue." The goal of the rescue is to restore normal blood production. This wouldn’t happen if normal stem cells were not given after high-dose treatment. Post-transplant recovery may take several weeks.
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