Thompson's Stem Cell Transplant Program Accredited by Prestigious National Organization Thompson Cancer Survival Center recently became East Tennessee's only FAHCT accredited Stem Cell Transplant Program. FAHCT, the Foundation for the Accreditation of Hematopoletic Cell Therapy, has bestowed this honor on only 61 sites in the nation. According to Dr. Rick Grapski, Thompson's program director, the process of accreditation is one of long-term commitment to the level of excellence necessary to be accredited by FAHCT. "This was an incredibly time-intensive process that took a team of professional clinicians over a year to complete. This accreditation assures patients that we have proven that we adhere to the most rigid of treatment protocols," Grapski stated. Thompson began this program in 1996 out of its desire to provide a Stem Cell Transplant Program to people in East Tennessee so they didn't have to travel out of state, away from their community and emotional support systems. And, now one of the most positive aspects of the program is that it is mostly outpatient. This means that patients do not require an overnight stay in the hospital. "We have found that being in familiar surroundings is best for the patient," comments Beverly Ely, Stem Cell Transplant Coordinator. Since its beginning, scores of patients have benefited from the transplant program. "It was also important for Thompson to provide this service because part of our center's mission is to stay abreast of the most current cancer care. But, an even more important part of our mission, and something we work very hard to do is to make that care available for anyone who comes here to be treated," says Dr. Grapski. The transplant program is a win-win for everyone involved. "Thompson is recognized as a leader in cancer care, committed to research and innovative treatment options. Because of this, we are invited to participate in some of the most leading edge clinical trials available. We are also now part of a national study group, SWOG (Southwest Oncology Group), studying the efficacy of high-dose chemotherapy in certain patients with poor prognosis cancers. This (affiliation) would not be possible were it not for our Stem Cell Transplant Program," Dr. Grapski explains. Stem cell transplant therapy is used to treat multiple myeloma, non-Hodgkin's lymphoma, certain leukemias, Hodgkin's disease, and testicular cancer. There are other potential uses for the stem cell transplant process, but those are presently in the clinical trials phase. So, what exactly is stem cell transplant therapy? Here are some of the most common questions and answers. Q. What are stem cells? A. Stem cells are immature cells that grow and divide into mature red blood cells, white blood cells, or platelets. Stem cells can be collected from the peripheral blood and/or from the bone marrow. The peripheral blood is the preferred source. Q. What do blood cells do? A. Normal cells are composed of white blood cells, red blood cells, and platelets. White blood cells protect against infection, red blood cells transfer oxygen to and from tissues in the body, and platelets are essential for blood clotting. Normal life is not possible without an adequate number of these cells. Q. What is a stem cell transplant? A. Autologous stem cell transplant is: 1. the removal of the peripheral stem cells 2. the storage of the cells 3. the transfusion of the cells back into the same person from whom the cells were removed. Q. Why is the stem cell transplantation performed? A. In general, stem cell transplantation is performed to allow the patient to recover from the complications of very high doses of chemotherapy and radiation therapy that we use to treat malignancies. Q. What are the complications from these high dose treatments? A. Primarily, low blood counts, which may lead to anemia, bleeding, and infection. Transfusion of blood and blood components, such as platelets, are usually successful in treating anemia and bleeding. Infection, even with the most appropriate antibiotics, can be difficult to treat. Given these complications, it is very important to shorten the period of low blood counts, which regularly follows high-dose chemotherapy. There is also the risk of other organ damage to the liver, lungs or kidneys. (Stem cell transplantation is a way to help recover from these complications.) Q. Does the stem cell transplant protect patients from these complications? A. No, not entirely. Until the transplanted blood stem cells start producing new blood cells, usually 10-14 days, patients have low blood counts and are at risk for these complications. Q. Why do we use high doses of chemotherapy? A. It is believed that higher doses of chemotherapy kill more tumor cells than standard doses. By increasing doses, we are attempting to prolong the time that a tumor is kept under control and hopefully a cure will result. Q. What patients are considered for intensive therapy and stem cell transplantation? A. Patients are considered if they fulfill the following requirements: 1. they have acceptable function of other organ systems 2. there is no evidence of active infection Certain cancers can be successfully treated such as lymphomas, multiple myeloma and certain types of leukemia. Q. How are the stem cells obtained? A. The cells are collected in a procedure involving the separation and collection of a particular type of white blood cell from the peripheral blood. The apheresis staff collects a certain class of white blood cells called leukopheresis. The cells are then frozen in liquid nitrogen. Q. Does it hurt? A. You will have a medical device called a central venous catheter placed into your chest by a physician. This will allow blood to be easily removed and returned during the collection. Staying relatively still for the procedure is necessary and may be uncomfortable. Q. What is done with the stem cells after the collection? A. The cells are sent to the Thompson Cancer Survival Center Stem Cell Processing Laboratory. The cells are mixed with DMSO (an agent that protects the cells during the freezing process) and then are carefully frozen. After being frozen, the cells are stored in a special freezer that keeps the marrow much colder than in a standard freezer. They are held until after your high-dose chemotherapy. Q. How is the actual transplant performed? A. Much like a standard blood transfusion. After you have completed the high-dose therapy, the frozen blood cells are brought to your room and then thawed. After thawing, the cells are placed in syringes and then given to you rapidly (over 5 minutes) intravenously. Q. What are the side effects of transplantation? A. Some patients experience mild nausea and/or vomiting. Other side effects may include cough, shortness of breath, flushing, and stomach cramps. Q. When does the stem cell transplantation begin to work? A. It usually takes 10-14 days for the cells to fully mature and start producing more white blood cells, red blood cells and platelets. Q. What are the complications (other than low blood counts) expected from high-dose chemotherapy? A. These depend on exactly what type of therapy is planned. Before you can receive the therapy, all the complications will be explained. A member of the transplant team will discuss everything in detail with you and address any questions you may have. Q. How effective is high-dose chemotherapy? A. The answer to this question depends on the exact type of tumor you have and what your past treatment has been. The projected benefits of high-dose chemotherapy will be discussed in detail before the therapy will be administered. In general, the risks of high-dose chemotherapy are greater than standard therapy; and, therefore, we believe that in many situations better control of your tumor can be achieved with this form of treatment as opposed to standard. If you have any questions or would like further information about Thompson's stem cell program, please call the nurse coordinator at 865-541-2161.