In many types of cancer, the dose of chemotherapy given is very important in achieving the best results. The use of very high doses of chemotherapy has been shown to cure some patients with cancer. However, these high dose therapies not only kill the invading cancer cells but can destroy healthy bone marrow as well. The stem cell transplant allows the physician to minimize serious complications by rebuilding the damaged bone marrow.

Giving high-dose chemotherapy followed by stem cell transplant does not provide a guarantee that the cancer will not reoccur, but it can increase the possibility of a cure or at least prolong the period of disease-free survival for many patients. It is important to remember that the stem cell transplant is not the treatment. The high-dose chemotherapy is the cancer treatment.

A stem cell transplant is similar to a bone marrow transplant except that the cells that are used to rebuild the bone marrow are collected from the patient's bloodstream rather than the bone marrow itself.

The harvest or collection of your stem cells is painless. Your catheter is used during the procedure. One lumen or chamber of the catheter is used to pull blood through the cell separating machine, the other lumen is used to return your blood to your body. The procedure s done on an outpatient basis over a 2 to 5 day period. Each day's collection will last approximately 3 to 4 hours.

Patients may have light-headedness, feel cold and/or numbness and tingling around the lips, or cramping in the hands or legs during the procedure. If any of these symptoms occur, medicine is given to relieve the problem. The nurses in the pherapheresis unit will monitor you very closely during the entire procedure.

After each day's collection, the stem cells are examined, counted to determine the number of stem cells and then frozen at very low temperature using a process called "cryopreservation". The processing and freezing takes place in the blood bank.

Both of these catheters will require flushing, cap and dressing changes. Your nurse will discuss the catheter care with you and teach you how to care for your catheter.

This chemotherapy will slow down the production of the white cells, red cells and platelets made in your bone marrow. Your blood counts will be drawn as seldom as three times a week and as often as daily to check your blood counts. The chemotherapy will make the white blood cell and platelet counts drop to very low levels. A very low white blood cell count is associated with an increased risk for infection. In the event of a fever, you will be hospitalized and given intravenous antibiotics until your temperature returns to normal and the white blood cell count has returned to a safe level. A low platelet count is associated with an increased risk of bleeding and to prevent that, you may be given platelet transfusions. As your bone marrow recovers, the number of white cells and stem cells in your blood increases, the stem cells will be collected or "harvested". This is done by a process called apheresis or pheresis.

The morning you are to receive your stem cells, your nurse will start intravenous fluids (hydration) which will continue throughout most of the day. Just before your infusion of stem cells, your nurse will give you medication to prevent any allergic reaction and/or nausea. Your vital signs (blood pressure, pulse, respiration, temperature and fluid intake) will be closely monitored by your nurse.

The side effects you may feel are temporary. You might notice a distinct taste at the beginning of the infusion; this is due to a preservative called DMSO that is added to the stem cells for the freezing and storage process. You may have red urine, some nausea, and elevated blood pressure. Any symptoms you may experience will subside with the completion of the infusion. Two to three days prior to stem cell infusion, you will start taking new medications. These are given prophylactically to reduce the risk of infection. These medications include an antibiotic to fight bacterial infection, and anti-fungal and anti-viral medications.

When a patient first faces the prospect of a stem cell transplant, the news can be devastating. Many will not yet have come to grips with the fact that they're suffering from a life threatening disease before being asked whether or not to undergo a stem cell transplant. Making this decision may have to be done quickly for the greatest likelihood of success. This adds stress to an already difficult situation.

The volume of information that patients and family must absorb with their unfamiliarity with medical terms can be overwhelming. Patients and family may need to ask many questions to comprehend the information provided.

• Don't hesitate to ask questions. Sometimes medical personnel assume that you know what's going on when you do not.
• Write things down, especially your questions. During your high-dose chemotherapy and cell transplant period, your memory can be short or unpredictable.
• Ask your doctor for names of former stem cell transplant patients with whom you can talk, or a support group you can attend.
• Ask for a tour of the transplant unit and a demonstration of equipment that will be used during your stay before you're admitted to the hospital.
• Take one day at a time.

• Don't hesitate to ask other family members and friends for help in caring for the patient, your family and you during the stem cell transplant. You'll need the help, and persons concerned about the patient's well-being will appreciate the opportunity to lend a hand.
• Be realistic about your limitations. Get enough sleep, eat properly, and take time off for yourself. You'll be a bigger help to the patient healthy and sane rather than sick and overwhelmed.
• Be prepared for changes in the patient's behavior. The drugs and stress may cause the patient to become depressed or angry. He or she may say things that don't make sense or see things that aren't there. These changes are only temporary but can frighten support persons when they occur.
• At the same time, understand that your loved one needs you now more than ever before. Your help is not only welcome - it's absolutely essential.
• Don't be shy about tracking down the medical staff to get help or answers to your questions. You'll feel better knowing the doctors are aware of problems you've noted, and you're entitled to have all your questions answered fully.
• Finally, remember that as helpless as you may sometimes feel, the moral support you provide is often the best "medicine" the patient can get.

AllogeneicStem Cell/ Bone Marrow Transplant Alopecia Anemia Antibiotic Apheresis Ascites Ataxia Audiogram Autologous Stem Cell Transplant Bacteria Baseline Test Bilirubin Biopsy Blood Tests: CBC BUN and Creatine Electrolytes TTD Bone Marrow Bone Marrow Biopsy and Aspiration Bone Scan Cardiac Catheter Chemo-responsive Central Venous Catheter Chemotherapy Chest X-Ray Chronic Clinical Trial CNS Colony Stimulating Factor

Cryopreservation CT Scan/ CAT Scan Cytomegalovirus Dermatitis Dysplasia Echocardiogram Edema EKG Electrolyte Emesis Engraftment Febrile Foley Catheter Fungus Gastrointestinal G-CSF GM-CSF Granulocytes Harvest Hematocrit Hemoglobin Hemorrhage Hemorrhagic Cystitis Hepato- Hepatitis Hyperalimentation Hyperpigmentation Hypertension Hypotension Iliac Crest

Immune System Immunocompromised Immunoglobulin Immunosuppression Intravenous Jaundice Leukocyte Lumen Lymphocyte Macrophage Malabsorption Metabolite Metastatic Mobilization Monocyte MRI Mucositis MUGA Scan Neuro- Neutropenia Neutrophils NPO Packed Red Blood Cells Pancytopenia Performance Status PeripheralNeuropathy Petechiae Phlebitis Plasma Platelets

Preparative Regimen Prognosis Prophylactic Protocol Pulmonary Pulmonary Function Test Purging Radiation Therapy RBC - Red Blood Cells Reinfusion Relapse Remission Renal Sepsis SGOT SGPT Stem Cell Steroid Stomatistis Total Parenteral Nutrition Tumor burden Ultrasound Urine Tests Veno-occlusive Disease Virus VOD WBC White Blood Cell Xerostomia