Your stem cell transplant consultation: Questions to ask

Your doctor may recommend that you undergo a stem cell transplant if you’ve been diagnosed with a blood cancer, such as leukemia, lymphoma or multiple myeloma, or a bone marrow failure syndrome like myelodysplastic syndrome or aplastic anemia. A stem cell transplant replaces blood cells that have been damaged by cancer and chemotherapy with healthy cells.

Before you move forward with a stem cell transplant, you’ll need to consult with a transplant doctor. We talked with Borje S. Andersson, M.D., Ph.D., about the best questions to ask to ensure that you feel comfortable with your treatment plan.

What type of stem cell transplant are you recommending for me?

There are several types of stem cell transplants, and the type you receive will help determine what’s needed from you prior to the transfusion as well as what to expect with your recovery. All stem cell transplants fall into two categories: autologous stem cell transplants, which use the patient’s own cells, and allogenic stem cell transplants, which use cells from a donor.

How will you find a donor for me?

We look through your family first: siblings, parents and children. Come prepared to discuss their medical histories. Mention things like cancer, heart problems, heavy smoking — anything that’s an alternative lifestyle.

If a related donor isn’t a possibility, there are other options, such as an umbilical cord blood transplant or finding an unrelated donor through Be The Match®, operated by the National Marrow Donor Program®.

Will I need other types of treatment?

A stem cell transplant is part of a treatment plan. Before the transplant, you’ll receive chemotherapy to kill the cancer, or in some cases, the defective bone marrow. When the new cells are transfused into your body, they will assist in killing any remaining cancer and replenish your body with healthy cells.

Some patients also receive low-dose chemotherapy as a maintenance treatment after the transplant. For instance, the majority of myeloma patients will be put on some sort of maintenance treatment that can go on for years. Patients with Hodgkin’s and non-Hodgkin’s lymphomas also may receive follow-up treatment -- most commonly radiation.

What are the risks associated with a stem cell transplant?

Stem cell transplants successfully put many cancer patients into remission, but as with any procedure, it’s important to talk to your doctor about the risks, some of which are life-threatening. Risks include side effects from the pre-transplant chemotherapy, graft-versus-host disease and infections.

Ask about the possibility of treatment-related death and what steps will be taken to lower your risk of complications.

What is graft-versus-host disease?

When receiving an allogeneic transplant, a patient’s cells may attack the donor cells after recognizing them as foreign. This is called graft-versus-host disease. Symptoms can be mild, such as a rash or loss of appetite, or severe, such as diarrhea or jaundice. Graft-versus-host disease can be life-threatening, but early detection and intervention can reduce the risk of long-term effects. Patients should be familiar with the signs so that they can seek care quickly. To lower the risk, patients are given immune-suppressive medications.

How long will I be in the hospital for my stem cell transplant?

You should plan on being in the hospital for four to six weeks. MD Anderson offers ambulatory treatment, so after you’re discharged, you’ll stay within a 5-mile radius of the hospital for the first 100 days after your transplant for close monitoring. This allows us to address any complications quickly. In some cases, the window from when a patient has a fever to when it’s a life-threating infection can be as short as just 30 minutes.

That’s also where a caregiver comes in. Your caregiver provides moral support and needs to be able to help the patient get back to the hospital, if needed. It may just be a phone call to 9-1-1, but that’s important and can be life-saving.

What will my life look like after I leave the hospital?

Although you may feel normal and your blood counts are normalizing, your immune system is still weak after a stem cell transplant. Six months to a year after the transplant, you’ll receive immunizations like an infant because your entire immunity has been reset. And you’ll need to be cautious about exposing yourself to germs. For example, exercise caution around kids, don’t garden in soil and be careful in crowded areas like movies theaters or restaurants.

Asking questions is one of the best ways to involve yourself in the decision-making process and enhance your quality of care. To make sure you get all of your questions answered, write down your questions in advance and take them to your consultation. It’s also a good idea to bring a friend or family member along to take notes. That way, you can absorb the information you need to make the best decision for you.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.