PERIPHERAL STEM CELL TRANSPLANT INTRODUCTION

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1 PERIPHERAL STEM CELL TRANSPLANT INTRODUCTION

2 This booklet was designed to help you and the important people in your life understand the treatment of high dose chemotherapy with stem cell support: a procedure known as PERIPHERAL STEM CELL TRANSPLANTATION. This booklet contains a great deal of information which can serve as a guide through your transplant experience. It is not, however, meant to replace talking to your doctor or other members of the transplant team. Someone is always available to assist you. A list of important numbers is provided below. If you call the answering service during the night or on weekends be sure to identify yourself as a stem cell transplant patient and that Dr. Jillella should be notified. Please talk with Dr. Jillella before you go to the emergency room. IMPORTANT NAMES AND PHONE NUMBERS ONCOLOGIST: Anand P. Jillella, MD (706) STEM CELLS STEM CELLS are the parent cells from which all other blood cells develop and mature. The three most important mature blood cells include white blood cells which help protect us from infection, red blood cells which carry oxygen to all parts of the body, and platelets which help clot the blood. STEM CELLS can be found in the spongy substance in the center of bones which is called bone marrow as well as in the bloodstream NIGHTS OR WEEKENDS (706) NURSE COORDINATOR: SOCIAL WORKER: PRIMARY NURSE: 5 SOUTH NURSING UNIT (706) (peripheral blood). PERIPHERAL STEM CELL TRANSPLANTATION HIGH-DOSE CHEMOTHERAPY is the best treatment at this time for your type of cancer. Unfortunately, these powerful anticancer drugs not only destroy cancer cells, they also damage normal cells of the body including stem cells. In order to make your treatment possible, stem cells

3 will be collected from your bloodstream before you receive high-dose chemotherapy then returned to you after you have received your treatment. A PERIPHERAL STEM CELL TRANSPLANT is similar to a bone marrow transplant except that the stem cells are collected from your bloodstream rather than from the bone marrow. A stem cell transplant is more effective as it is usually associated with faster bone marrow recovery and a shorter hospital stay. PERIPHERAL STEM CELL TRANSPLANTATION does not guarantee that your cancer will be cured, however, it can increase the possibility of a cure in certain cancers. If cure is not possible, there is an excellent chance that a prolonged disease-free period will be obtained. Steps of the PERIPHERAL STEM CELL TRANSPLANT are listed below. They are listed in the order in which they occur to help clarify the transplant process. Some of the steps of the transplant will require that you be in the hospital while others can be done as an outpatient. Your doctor will tell you when you must be in the hospital. DIAGNOSTIC TESTS BLOOD TESTS 1. CBC --- complete blood count, including white blood cell count, hemoglobin, hematocrit, and platelet count. 2. BLOOD CHEMISTRIES --- test which reflect liver, kidney, heart and other organ function. 3. TUMOR MARKER --- biochemical indicator of the presence of tumor growth. BONE MARROW ASPIRATION AND BIOPSY -- - test in which a needle is placed into your posterior illiac crest (pelvic bone) and marrow is withdrawn and a piece of bone is removed. CT SCAN --- computerized tomography is a special x-ray which shows detailed pictures of body organs. MRI --- magnetic resonance imaging is a special scan of

4 body organs and tissues using magnetic fields rather than radiation. MUGA SCAN --- a diagnostic scan which evaluates the motion of the heart walls and efficiency of the contraction and pumping of the heart. PFT S --- pulmonary function tests evaluate how well your lungs are able to GLOSSARY ANTIBIOTIC --- a drug given to fight bacterial infection. APHERESIS --- a technique used to separate blood into different components in order to collect stem cells and return remaining cells back to the bloodstream. BONE MARROW --- soft, spongy tissue in the hollow of bones where blood cells are produced. CENTRAL VENOUS CATHETER --- a small flexible tube inserted just below the collarbone which is threaded into a large vein. This catheter can be used to give fluids and drugs as well as to oxygenate your body. URINE TEST 1. URINALYSIS --- a test to monitor for infection or metabolic abnormalities HOUR URINE COLLECTION --- analysis of total urine collection in a 24 hour period. draw blood. CHEMOTHERAPY --- drug or combination of drugs given to destroy cancer cells. ENGRAFTMENT --- the process in which reinfused stem cells travel to the bone marrow and begin producing new blood cells. GRANULOCYTE COLONY STIMULATING FACTOR --- a protein which stimulates the production and growth of a specific type of white blood cell. HIGH DOSE CHEMOTHERAPY --- a drug or combination of drugs given in very high doses to try to completely eradicate the cancer. Sometimes referred to as the conditioning

5 regimen. MOBILIZATION --- process by which stem cells are encouraged to mature, reproduce, and migrate to the bloodstream. STEM CELLS --- the immature or parent cell from which all blood cells develop. SUBCUTANEOUS INJECTIONS --- a drug inserted into the fatty tissue under the skin with a small needle and syringe. 1. Central Venous Catheter Placement 2. Mobilizing Chemotherapy Administration 3. Granulocyte Colony Stimulating Factor (G-CSF) Administration 4. Stem Cell Collection (Apheresis) 5. High Dose Chemotherapy Administration 6. Reinfusion of Peripheral Stem Cells 7. Recovery CENTRAL VENOUS CATHETER Before your treatment begins you will have a CENTRAL VENOUS CATHETER inserted. The catheter is placed in the chest, one to two inches below the collarbone. This is usually done as an GRANULOCYTE COLONY STIMULATING FACTOR (G-CSF) An additional treatment will be given after the mobilizing chemotherapy to stimulate the out-patient surgical procedure. This flexible tube with two or three branches (lumens) will be used to collect stem cells (apheresis), administer intravenous (IV) fluids, draw blood, and return your stem cells to your bloodstream. The catheter site must be kept clean and dry and each lumen of the catheter will need to be flushed on a routine basis with a drug (heparin) which prevents blood clotting in the catheter. Your nurse will provide detailed instructions on how to care for your catheter. MOBILIZING CHEMOTHERAPY In order for the bone marrow to move an increased number of stem cells into the bloodstream, chemotherapy will be administered. Soon after chemotherapy is administered high levels of stem cells appear in the bloodstream to help your blood counts recover. This treatment is known as MOBILIZING CHEMOTHERAPY. In addition to destroying cancer cells, chemotherapy will also destroy normal bone marrow cells which can lead to infection and bleeding. You may require IV antibiotics and/or transfusions, which can also cause other side effects. You will receive verbal and written information of these side effects from your doctor and nurse. production and growth of stem cells. GRANULOCYTE COLONY STIMULATION FACTOR (F-CSF) is a drug which helps your bone marrow make more stem cells. G-CSF is injected daily with a small needle into the fatty

6 layer under the skin. You will receive your first injection of G-CSF the day after your mobilizing chemotherapy treatment. These injections will continue until an adequate number of stem cells have been collected. You may experience mild to moderate bone pain when receiving this drug. You or a care giver will be taught how to give G- CSF injections and how to manage the mild side effects of this drug. STEM CELL COLLECTION (APHERESIS) As your white blood cell count increases, stem cells will be collected or harvested by a process known as APHERESIS. A special apheresis machine will remove your stem cells. In order to remove stem cells, eight to ten quarts of blood will circulate through the apheresis machine. The stem cell portion of your blood cells will be collected by the machine while the rest of your blood will be returned to you. Your central venous catheter is generally used for the stem cell collection although an arm vein can be used if necessary. One branch or lumen of the catheter is used to draw blood through the apheresis machine, another lumen returns blood back to your body. This procedure is repeated daily for two to five days, until an adequate number of stem cells has been collected. Each day s collection will take about three to four hours. The stem cells are counted daily, then frozen (cryopreserved) until the day of reinfusion into your bloodstream. While you are connected to the apheresis machine you might experience dizziness, numbness or tingling in your arms and legs or around the lips, and muscle cramps. These side effects are easily relieved; just alert your apheresis nurse of your symptoms. Your vital signs will be monitored frequently, and someone will be with you at all times. HIGH-DOSE CHEMOTHERAPY After enough stem cells have been collected and frozen, you will receive more chemotherapy. HIGH-DOSE CHEMOTHERAPY is given with the intention of destroying cancer cells more effectively than is possible with small doses or standard-dose chemotherapy. The chemotherapy drugs that you will receive will be determined by the type and stage of your cancer. You may received more than one cycle of high-dose chemotherapy. You most likely will experience side effects from chemotherapy including nausea and vomiting, sore mouth, diarrhea, skin rashes and hair loss. Your bone marrow will be suppressed for several weeks leading to a very low white blood cell count, decreased red blood cell count and decreased platelet count. You will receive oral medications to help protect against infections and you may require IV transfusions with red blood cells or platelets. Your nurse will review the side effects of chemotherapy with you and you will be monitored closely during this period of bone marrow suppression. REINFUSION OF PERIPHERAL STEM CELLS A day or two after you receive high-dose chemotherapy your stem cells will be returned to you. Your stem cells will be thawed and infused through your catheter over several minutes. You and those around you may notice an unusual odor or taste caused by the preservative used to protect stem cells during storage. This odor may be present during reinfusion and for several days afterwards. Medication will be given prior to receiving your stem cells to prevent the possibility of certain side effects such as chills and fever. You will be watched closely for any side effects which might occur during the reinfusion of your stem cells. RECOVERY

7 The newly infused stem cells will travel to your bone marrow where they will begin making new blood cells. This process known as engraftment normally takes 10 to 14 days. Your blood counts will be monitored daily until signs of engraftment are evident, then less often until your bone marrow has completely recovered from chemotherapy. Once your recovery is complete you will continue to be followed by your doctor. You will have physical examinations, blood work, x-rays, and other diagnostic tests on a routine schedule determined by you and your doctor. If you have problems in between your visits call your doctor or nurse. We are always available to help you.

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