Are Stem Cell Transplants Done...

[westieluv]

on people who are not in remission from their cancer? I know someone who has MCL, and he was told that his chemo was not effective and did not put him in remission. His doctor is still talking about an allogenic SCT, but everything I read says that SCT won't work on someone who is not in remission.

[mappers]

I have to admit that I am not an expert on stem cell transplants, but I'm pretty sure our patients that get these are not in remission. As a matter of fact, I know we talk about debulking the tumor burden with chemo to get them to transplant. If you are in remission, why would you do one?

Transplant nurses should weigh in here. For allo-transplants, don't they treat the marrow somehow before reintroduction? Or am I way off?

[westieluv]

Most of what I can find on the subject says that stem cell transplants are designed to rebuild the immune system of someone who has no immune system left due to massive doses of chemo and radiation, but that they don't cure the cancers that don't respond to chemotherapy.

[mappers]

I believe the whole purpose of the transplants is to replace unhealthy bone marrow with healthy. Hence they kill the patient's bone marrow with high-dose chemo, then reintroduce healthy marrow, either from a donor or from the patients themselves. The marrow is where the cancer is, which is why they want to destroy it. It is not to replace marrow that is incidentally killed by treatment meant to treat something else.

So, no, they won't remission to do a stem cell transplant. I work with adults however. If you are talking about Peds....I have no idea.

[westieluv]

I should have mentioned, this person has a large, inoperable, cancerous mass in his neck that was untouched by the heavy doses of chemo. What do they do in a case like that, where the cancer isn't just in the bone marrow? Then would a stem cell transplant do any good?

[KelRN215, BSN, RN]

Generally, with a cancer that is not in the bone marrow, the reason to do a stem cell transplant is as a rescue. These patients get autologous stem cell transplants where they get their own cells back. Chemotherapy is given in extremely high doses that completely wipe out the bone marrow and then transplant is done as a rescue. When I worked in the hospital, this was done for some of our neuro-onc population- children under 3 with malignant tumors who they didn't want to get radiation d/t the risk of neurotoxicity and for patients who'd completed the standard treatments and then relapsed.

For patients with relapsed or refractory leukemia, they generally proceed to stem cell transplant to replace their diseased bone marrow with healthy bone marrow as mappers said. The treatment course depends on the cancer. I have had several patients with AML who went directly to transplant following induction chemotherapy. A few who developed secondary AML after treatment for ALL and then went straight to transplant. Several more who had 1-2 autologous transplants for neuroblastoma.

[mappers]

Thanks KelRN, that makes sense. Like I said earlier, if a patient is in remission, why would they need to do a transplant?

[westieluv]

Yes, thanks for the clarification. In the meantime, he has learned that the cancer is throughout most of his entire neck, not just the thyroid as he had hoped. The plan is for heavy radiation to the area, he has been told it may take up to six months to take effect. In the meantime, can a stem cell transplant be done while he undergoes the radiation, or will he have to wait until after that treatment?

[mappers]

It sounds like in his case the cancer is not in his bone marrow, therefore a SCT would be a rescue to high dose chemotherapy. They would do radiation to debulk the tumor then the high dose chemo next, not at the same time. Again, the SCT is NOT the treatment in this case (at least based on what you are describing.)

[KelRN215, BSN, RN]

No, you cannot go through stem cell transplant at the same time as radiation. Stem cell transplant requires a prolonged inpatient stay and isolation. Radiation is a daily treatment (usually 5 days/week) given over a 6 week period. Someone in the immediate post-transplant period cannot be transported back and forth to radiation every day. Patients are very sick while in stem cell... the vast majority end up on TPN, on PCAs and need to be monitored very closely for potentially fatal complications. Stem cell transplant, as mappers points out here, is not a treatment for this individual's cancer. It sounds like this individual would be a candidate for an allogenic stem cell transplant/rescue. That requires a lot of preparation as they need to harvest stem cells first and that typically happens several months before transplant.

[westieluv]

So bear with me here, since this is obviously not my field of expertise, but if this person was told that he has a very aggressive NHL, then while the tumor in his thyroid is being radiated for weeks or months, couldn't the cancer be aggressively spreading to other parts of his body, since he also has many other tumors in his lower neck? Even if the radiation covers the entire neck region, couldn't the cancer still be spreading, since radiation may shrink the tumors but not kill the cancer cells?

Again, I am no oncology nurse, but this whole thing seems to be wasting a lot of time that he doesn't necessarily have. That was my main concern, but I also know that the oncologists know a whole lot more than I do.