MedStar Washington Hospital Center

At the MedStar Georgetown Cancer Institute, we provide the full spectrum of care for our patients. We want you to feel informed and prepared for your stem cell transplant procedures. Our team will take the time to explain every step in detail and answer any questions you may have. We tailor your treatment plan for your needs, factoring in your age, general health and specific condition. Our team will discuss your individual transplantation process with you.

Establishing Candidacy

Our expert transplantation team works with you to determine your candidacy. The evaluation process, which may last a few days, includes many different types of tests:

• Thorough physical examination and review of your medical history
• Blood tests
• Imaging scans, including chest X-rays and computed tomography (CT) scans
• Tests to check your heart, lung, and other organ functions
• Bone marrow biopsy (removing a small piece of your bone marrow for analysis), which gives us a deeper understanding of your condition
• Psychosocial evaluation

You may begin the process by either:

• Referring yourself directly to our program by calling 202-444-3736
• Having your hematologist/oncologist refer you to one of our transplant physicians

Preparation

Your overall health contributes greatly to the success of your transplant. At the MedStar Georgetown Cancer Network, we want to ensure that you are in the best health possible before your procedure. Our pre-transplant coordinators and support staff will help guide you through the preparation phase, helping you lower your risk of complications and increase your chances for a positive, long-term outcome. They may recommend some exams or tests prior to your transplant, to treat existing infections and plan for your postoperative care. These include:

• Dental exam: It’s important to treat any sources of infection. Your dentist may also recommend fluoride treatments to prevent decay.
• Gynecological exam: Women are required to undergo a gynecological exam before transplantation to treat any infections.
• Dietary changes: We will most likely place you on a special diet before your procedure. Our experienced dietitian will create a personalized food plan that meets your nutritional needs. In addition, achieving a close-to-normal weight can contribute to a better result. Our dietitian can work with you to help you gain or lose weight safely and effectively.
• Fertility planning: Chemotherapy and radiation can cause sterility (inability to have children). Talk to your doctor about banking sperm or ova if you wish to start or add to your family after the procedure. We can also make a referral for you to a fertility center.
• Baseline tests: We will run a number of tests before the procedure to establish baseline information. This gives us a detailed picture of your body’s current health and functioning so we can evaluate any changes that occur during or after the procedure. Tests include imaging scans, a hearing test and a heart evaluation.

We will then begin preparing you for the actual procedure.

Harvesting

Once we have completed the evaluation and determined that you are a transplant candidate, we will begin the first step: a harvesting procedure. We will collect the cells from you or from a donor, depending on the type of transplant procedure you are having:

• Allogeneic: We harvest healthy cells from a family member or unrelated donor.
• Autologous: We harvest your own cells. We collect the cells from the bloodstream (or, occasionally, from the marrow) and store them for transplant.

Bone Marrow Harvesting

Bone marrow or peripheral blood stem cell harvesting is the first step in your transplant process. During harvesting, we obtain the stem cells we need for your transplant. We may harvest the cells from you, a relative, or an unrelated donor, or we may obtain cells from an umbilical cord.

At MedStar Georgetown University Hospital, we have unique expertise in this area. We are home to the National Marrow Donor Program, the largest marrow and blood stem cell harvesting site in the nation. This high volume gives our team a superior level of experience and expertise in cell collection.

The timing of the harvesting procedure depends on the type of transplant you are having:

• If the bone marrow is coming from a donor, we will harvest it from him/her on the day of the transplant procedure.
• If we are harvesting the bone marrow from you, we will harvest these cells before you receive chemotherapy conditioning for transplantation.

With either you or your donor under general or spinal anesthesia, your specialist will remove a small portion of bone marrow from your or the donor’s hips with a syringe. The amount of marrow taken depends on the patient’s weight and the specific condition to be treated. The body can replace marrow in about two weeks.

Stem Cell Harvesting

Blood stem cell harvesting is another way to obtain the stem cells needed for transplantation.

Your specialist will place a needle into a vein in each of your arms to collect blood into a leukapheresis machine, which removes the white blood cells and returns the other blood cells back to the patient. For some patients, a catheter will be placed into a vein to gain access to blood. This collection procedure has few side effects, and our experienced transplantation nurses will monitor you regularly and a physician will be onsite at all times.

You will be awake the entire time, and after the session, you may go home.

Radiation and Chemotherapy

After the cells are harvested, you will receive radiation and/or chemotherapy to kill cancer cells and prepare your body for the transplant. This type of treatment is called conditioning and is necessary for a few reasons:

• If you are receiving donor cells (allogeneic transplantation), chemotherapy and/or radiation therapy suppresses your immune system so your body does not reject the new cells. If you have cancer, it also helps destroy the tumor.
• If you are receiving your own treated cells (autologous transplantation), chemotherapy or radiation can be used immediately before the transplant to destroy any tumors.

Radiation therapy

You may receive one of two types of radiation therapy:

• Targeted radiation therapy treats a specific area of your body.
• Total body irradiation (TBI) is administered to your entire body.

Chemotherapy

Chemotherapy is another treatment that rids the body of cancer or blood disease. Chemotherapy is a mixture of medications that destroys diseased tissue. Depending on your particular condition, we may need to administer one or more types of chemotherapy (with or without radiation therapy) as part of your transplantation treatment. Our goal is to rid your body of all traces of the disease. We may administer the drugs intravenously (an IV) or in pill form.

Features of MedStar Georgetown University Hospital’s radiation and chemotherapy program include:

• Convenience: Everything you need for your care is located onsite. If we recommend chemotherapy or radiation therapy, you can usually receive the necessary treatments at our facility. We provide for all aspects of your care at MedStar Georgetown. In some cases, we may recommend that your referring physician give you chemotherapy or radiation before your transplantation in the management of our disease leading up to the transplant.
• Seamless communication: Your transplant team will work closely with the chemotherapy and radiation teams. We provide continuous, integrated care and communicate regularly regarding your treatment.
• Expert team: Our radiation and chemotherapy team has years of experience working with these patients. We will help you manage any side effects and discomfort you may experience. 

Infusion and Transplantation

Once we have finished the harvesting, we can begin the procedure. The actual stem cell transplant procedure is relatively quick and simple. You may be receiving your own bone marrow/stem cells or bone marrow/stem cells from a donor. In either case, the transplant resembles a blood transfusion. There are generally few side effects.

Here is a general idea of what you can expect:

• We give you medicine approximately 30 minutes before the infusion to help reduce any potential side effects.
• The stem cells are injected through your IV catheter.
• You remain awake during the procedure; it will not hurt.
• The process takes anywhere from 30 minutes to four hours. The amount of time depends on the amount of fluid in the stem cell product.

Recovery

After your transplant, you will need to remain in the hospital’s transplant unit for two to three weeks, until your bone marrow is functioning normally. While you are recovering, our experienced, dedicated transplant nurses will care for you. During this period, we will test your blood daily to track your progress. We will also monitor you carefully for side effects from chemotherapy and radiation, as well as for infections, graft vs. host disease (if you have an allogeneic transplant), and graft failure.