Stem Cell/Bone Marrow Transplant
What is graft-versus-host (GVHD) disease?
Graft-versus-host-disease (GVHD) is a complication of allogeneic stem cell transplantation in which lymphocytes from the donor stem cells see the recipient's cells as foreign. As a result, these lymphocytes react against the tissues of the patient causing GVHD. GVHD manifests particularly in the skin, liver, and gastrointestinal tract.
What are the consequences of GVHD?
GVHD may manifest itself in a variety of ways and range from mild to severe. Mild GVHD may appear as a minor skin rash treatable with steroids. Mild reactions are usually a sign of better outcome because it can be evidence that graft-versus-leukemia if taking effect. Graft-versus-leukemia effect means that the donor's cells are attacking the patient's leukemia cells and helping to erradicate the leukemia.
In severe GVHD, more aggressive therapy must be done. If your physician recommends that you have aggressive therapy to combat GVHD, discuss the ramifications and duration so that you can understand the consequences.
Does my blood type change after SCT or BMT?
Yes. The recipients blood type eventually changes to the donor type. That means if you had a blood type of A+ prior to transplant and your donor had a blood type of O, eventually your blood type would become O. I may take several weeks, possibly months for your original blood type to disappear, but eventually it will.
Will I develop my donor's allergies?
Although this has happened before, it is extremely rare and is not considered a major factor in the decision process for undergoing a transplant. Since there is usually only one suitable donor, the benefit of the transplant far outweighs the risk of contracting an allergy.
What are the differences between acute and chronic GVHD?
Acute GVHD usually develops in the first 100 days following a transplant. Thus, you will see many transplant patients remain either hospitalized or staying in close proximity to their transplant center. Acute GVHD may include the skin, liver, and gastrointestinal tract and primarily lead to skin rash, jaundice, and diarrhea. Chronic GVHD is more subtle and may include the eyes or mouth becoming dry, a rash in the mouth, thickening or tightening of the skin, as well as chronic liver issues.
I am beyond the age range for a stem cell transplant, but my doctor is recommending a "reduced intensity" stem cell transplant. What is this?
Doctors are studying a type of stem cell transplant called a reduced-intensity transplant, or non-myeloablative stem cell transplant. This type transplant may be helpful for older patients, or others who are not eligible for allogeneic stem cell transplantation.
What is a Donor Lymphocyte Infusion?
A Donor Lymphocyte Infusion (DLI) is an infusion of white cells called lymphocytes from a donor. DLI is generally used when a patient's CML has returned following an allogeneic stem cell transplant. Patients that experience a relapse after SCT may be treated with Imatinib, Dasatinib, or Nilotinib prior to proceeding to a Donor Lymphocyte Infusion. When DLI is used in patients that have had a stem cell transplant, the lymphocytes are taken from the original stem cell donor, if at all possible.
What is the difference between a bone marrow transplant and a stem cell transplant?
Transplants for CML involve the eradication of the patient's own blood cells, both leukemic and healthy cells, followed by its replacement with stem cells which are healthy and free of leukemia. The difference in a bone marrow transplant and a stem cell transplant, is simply the location from which the donor stem cells are taken. For example, blood stem cells can be found in the bone marrow and in the peripheral blood (circulating blood). A bone marrow transplant involves "harvesting" the stem cells from the bone marrow of a donor volunteer and after being prepared and grown, giving them to the patient. Stem cell transplants involve "harvesting" stem cells from the circulating blood of a donor volunteer, preparing and growing them in a laboratory and then giving them to the patient. The stem cells may come from a person closely related to the patient, a stranger whose blood has characteristics completely or nearly identical to the patient's, or the patient him or herself. For a step by step presentation of the differences in bone marrow and stem cell transplant options for patients, please look at this Transplant Slide Presentation.