AdrenoLeukoDystrophy Awareness
Showing posts with label Bone Marrow Transplant Articles. Show all posts
Showing posts with label Bone Marrow Transplant Articles. Show all posts
Thursday, October 22, 2009
Sunday, July 5, 2009
What complications and side effects may occur following BMT?
What complications and side effects may occur following BMT?
Complications may vary, depending on the following:
•type of marrow transplant
•type of disease requiring transplant
•preparative regimen
•age and overall health of the recipient
•variance of tissue matching between donor and recipient
•presence of severe complications
The following are complications that may occur with a bone marrow transplantation. However, each individual may experience symptoms differently. These complications may also occur alone, or in combination:
•infections
Infections are likely in the patient with severe bone marrow suppression. Bacterial infections are the most common. Viral and fungal infections can be life threatening. Any infection can cause an extended hospital stay, prevent or delay engraftment, and/or cause permanent organ damage. Antibiotics, anti-fungal medications, and anti-viral medications are often given to prevent serious infection in the immunosuppressed patient.
•low platelets and low red blood cells
Thrombocytopenia (low platelets) and anemia (low red blood cells), as a result of a non-functioning bone marrow, can be dangerous and even life threatening. Low platelets can cause dangerous bleeding in the lungs, gastrointestinal (GI), and brain.
•pain
Pain related to mouth sores and gastrointestinal (GI) irritation is common. High doses of chemotherapy and radiation can cause severe mucositis (inflammation of the mouth and GI tract).
•fluid overload
Fluid overload is a complication that can lead to pneumonia, liver damage, and high blood pressure. The primary reason for fluid overload is because the kidneys cannot keep up with the large amount of fluid being given in the form of intravenous (IV) medications, nutrition, and blood products. The kidneys may also be damaged from disease, infection, chemotherapy, radiation, or antibiotics.
•respiratory distress
Respiratory status is an important function that may be compromised during transplant. Infection, inflammation of the airway, fluid overload, graft-versus-host disease, and bleeding are all potential life-threatening complications that may occur in the lungs and pulmonary system.
•organ damage
The liver and heart are important organs that may be damaged during the transplantation process. Temporary or permanent damage to the liver and heart may be caused by infection, graft-versus-host disease, high doses of chemotherapy and radiation, or fluid overload.
•graft failure
Graft failure is a potential complication. Graft failure may occur as a result of infection, recurrent disease, or if the stem cell count of the donated marrow was insufficient to cause engraftment.
•graft-versus-host disease
Graft-versus-host disease (GVHD) can be a serious and life-threatening complication of a bone marrow transplant. GVHD occurs when the donor's immune system reacts against the recipient's tissue. The new cells do not recognize the tissues and organs of the recipient's body. The most common sites for GVHD are GI tract, liver, skin, and lungs.
Long-term outlook for a bone marrow transplantation:
Prognosis greatly depends on the following:
•type of marrow transplant
•type and extent of the disease being treated
•disease response to treatment
•genetics
•your age and overall health
•your tolerance of specific medications, procedures, or therapies
•severity of complications
Complications may vary, depending on the following:
•type of marrow transplant
•type of disease requiring transplant
•preparative regimen
•age and overall health of the recipient
•variance of tissue matching between donor and recipient
•presence of severe complications
The following are complications that may occur with a bone marrow transplantation. However, each individual may experience symptoms differently. These complications may also occur alone, or in combination:
•infections
Infections are likely in the patient with severe bone marrow suppression. Bacterial infections are the most common. Viral and fungal infections can be life threatening. Any infection can cause an extended hospital stay, prevent or delay engraftment, and/or cause permanent organ damage. Antibiotics, anti-fungal medications, and anti-viral medications are often given to prevent serious infection in the immunosuppressed patient.
•low platelets and low red blood cells
Thrombocytopenia (low platelets) and anemia (low red blood cells), as a result of a non-functioning bone marrow, can be dangerous and even life threatening. Low platelets can cause dangerous bleeding in the lungs, gastrointestinal (GI), and brain.
•pain
Pain related to mouth sores and gastrointestinal (GI) irritation is common. High doses of chemotherapy and radiation can cause severe mucositis (inflammation of the mouth and GI tract).
•fluid overload
Fluid overload is a complication that can lead to pneumonia, liver damage, and high blood pressure. The primary reason for fluid overload is because the kidneys cannot keep up with the large amount of fluid being given in the form of intravenous (IV) medications, nutrition, and blood products. The kidneys may also be damaged from disease, infection, chemotherapy, radiation, or antibiotics.
•respiratory distress
Respiratory status is an important function that may be compromised during transplant. Infection, inflammation of the airway, fluid overload, graft-versus-host disease, and bleeding are all potential life-threatening complications that may occur in the lungs and pulmonary system.
•organ damage
The liver and heart are important organs that may be damaged during the transplantation process. Temporary or permanent damage to the liver and heart may be caused by infection, graft-versus-host disease, high doses of chemotherapy and radiation, or fluid overload.
•graft failure
Graft failure is a potential complication. Graft failure may occur as a result of infection, recurrent disease, or if the stem cell count of the donated marrow was insufficient to cause engraftment.
•graft-versus-host disease
Graft-versus-host disease (GVHD) can be a serious and life-threatening complication of a bone marrow transplant. GVHD occurs when the donor's immune system reacts against the recipient's tissue. The new cells do not recognize the tissues and organs of the recipient's body. The most common sites for GVHD are GI tract, liver, skin, and lungs.
Long-term outlook for a bone marrow transplantation:
Prognosis greatly depends on the following:
•type of marrow transplant
•type and extent of the disease being treated
•disease response to treatment
•genetics
•your age and overall health
•your tolerance of specific medications, procedures, or therapies
•severity of complications
The bone marrow transplant procedure:
bone marrow transplant
The bone marrow transplant procedure:
The preparations for a bone marrow transplant vary depending on the type of transplant, the disease requiring transplant, and your tolerance for certain medications. Consider the following:
•Most often, high doses of chemotherapy and/or radiation are included in the preparations. This intense therapy is required to effectively treat the malignancy and make room in the bone marrow for the new cells to grow. This therapy is often called ablative, or myeloablative, because of the effect on the bone marrow. The bone marrow produces all the blood cells in our body. Ablative therapy prevents this process of cell production and the marrow becomes empty. An empty marrow is needed to make room for the new stem cells to grow and establish a new production system.
•After the chemotherapy and/or radiation is administered, the marrow transplant is given through the central venous catheter into the bloodstream. It is not a surgical procedure to place the marrow into the bone, but is similar to receiving a blood transfusion. The stem cells find their way into the bone marrow and begin reproducing and establishing new, healthy blood cells.
•Supportive care is given to prevent and treat infections, side effects of treatments, and complications. This includes frequent blood tests, close monitoring of vital signs, strict measurement of input and output, daily weigh-ins, and providing a protected and sterile environment.
The days before transplant are counted as minus days. The day of transplant is considered day zero. Engraftment and recovery following the transplant are counted as plus days. For example, a patient may enter the hospital on day -8 for preparative regimen. The day of transplant is numbered zero. Days +1, +2, etc., will follow. There are specific events, complications, and risks associated with each day before, during, and after transplant. The days are numbered to help the patient and family understand where they are in terms of risks and discharge planning.
During infusion of bone marrow, the patient may experience the following:
•pain
•chills
•fever
•hives
•chest pain
After infusion, the patient may:
•spend several weeks in the hospital.
•be very susceptible to infection.
•experience excessive bleeding.
•have blood transfusions.
•be confined to a sterile environment.
•take multiple antibiotics and other medications.
•be given medication to prevent graft-versus-host disease - if the transplantation was allogeneic. The transplanted new cells (the graft), tend to attack the patient's tissues (the host), even though the donor is a relative, such as a brother, sister, or parent.
•undergo continual laboratory testing.
•experience nausea, vomiting, diarrhea, mouth sores, and extreme weakness.
•experience temporary mental confusion and emotional or psychological distress.
After leaving the hospital, the recovery process continues for several months or longer, during which time the patient cannot return to work or many previously enjoyed activities. The patient must also make frequent follow-up visits to the hospital or physician's office.
The bone marrow transplant procedure:
The preparations for a bone marrow transplant vary depending on the type of transplant, the disease requiring transplant, and your tolerance for certain medications. Consider the following:
•Most often, high doses of chemotherapy and/or radiation are included in the preparations. This intense therapy is required to effectively treat the malignancy and make room in the bone marrow for the new cells to grow. This therapy is often called ablative, or myeloablative, because of the effect on the bone marrow. The bone marrow produces all the blood cells in our body. Ablative therapy prevents this process of cell production and the marrow becomes empty. An empty marrow is needed to make room for the new stem cells to grow and establish a new production system.
•After the chemotherapy and/or radiation is administered, the marrow transplant is given through the central venous catheter into the bloodstream. It is not a surgical procedure to place the marrow into the bone, but is similar to receiving a blood transfusion. The stem cells find their way into the bone marrow and begin reproducing and establishing new, healthy blood cells.
•Supportive care is given to prevent and treat infections, side effects of treatments, and complications. This includes frequent blood tests, close monitoring of vital signs, strict measurement of input and output, daily weigh-ins, and providing a protected and sterile environment.
The days before transplant are counted as minus days. The day of transplant is considered day zero. Engraftment and recovery following the transplant are counted as plus days. For example, a patient may enter the hospital on day -8 for preparative regimen. The day of transplant is numbered zero. Days +1, +2, etc., will follow. There are specific events, complications, and risks associated with each day before, during, and after transplant. The days are numbered to help the patient and family understand where they are in terms of risks and discharge planning.
During infusion of bone marrow, the patient may experience the following:
•pain
•chills
•fever
•hives
•chest pain
After infusion, the patient may:
•spend several weeks in the hospital.
•be very susceptible to infection.
•experience excessive bleeding.
•have blood transfusions.
•be confined to a sterile environment.
•take multiple antibiotics and other medications.
•be given medication to prevent graft-versus-host disease - if the transplantation was allogeneic. The transplanted new cells (the graft), tend to attack the patient's tissues (the host), even though the donor is a relative, such as a brother, sister, or parent.
•undergo continual laboratory testing.
•experience nausea, vomiting, diarrhea, mouth sores, and extreme weakness.
•experience temporary mental confusion and emotional or psychological distress.
After leaving the hospital, the recovery process continues for several months or longer, during which time the patient cannot return to work or many previously enjoyed activities. The patient must also make frequent follow-up visits to the hospital or physician's office.
Sunday, April 19, 2009
Possible Late Effects of Your Child's Transplant
Growth problems
Doctors will check your child's height and weight regularly after transplant to see if he or she is growing as expected. If your child does not grow at a normal rate, an endocrinologist (doctor who is a hormone specialist) can assess your child. Some drugs common after transpant can affect growth. If tests show your child's body is not making enough growth hormone, growth hormone therapy may help. If your child does not have the growth spurt that comes with puberty, treatment with sex hormone replacement therapy may be an option. Doctors are still learning more about who may or may not benefit from each kind of hormone therapy. Although some children do not grow as tall as expected, most grow to within the normal adult range.
InfertilityMost people treated with a bone marrow or cord blood transplant become infertile. The treatments your child receives before transplant and your child's age at treatment affect the chances he or she will be infertile. Before transplant, talk with your child and your child's doctor about this risk. Older children who have gone through puberty may be able to take steps to provide options for having a child in the future. Before transplant, older boys may be able to have sperm frozen. Older girls may be able to have eggs frozen. However, these methods are not an option for everyone and do not always work. You can ask your child's doctor whether these or other options are available for your child.
Your child will also need to know that not everyone who has a transplant becomes infertile. Some transplant survivors have gone on to have children. When your child is ready to think about these questions, encourage him or her to talk with a doctor, either with or without you present. You can get more information from the non-profit organization Fertile Hope at www.fertilehope.org.
Changes in memory or learning
For many children, transplant has no effect on learning. However, some children have changes in the ways they can learn or remember information. Children who are older at transplant have a low risk of such changes. The risk may be higher for very young children. [1, 2] The risk may also be higher for children who had disease in the central nervous system or had radiation treatments. Changes in learning can appear soon after transplant, but often do not surface until years later. For example, a memory problem may not appear until a child tries to learn multiplication tables.
If your child's learning is affected, you can work with the school to meet your child's needs. Watch for drops in your child's grades or increased feelings of frustration with school. Other signs you and your child's teacher can watch for include problems with:
Understanding what he or she reads
Needing much more time and effort to complete work than other children do
Math, such as remembering multiplication tables or organizing math problems
Remembering, understanding and using information that he or she reads or sees, while having an easier time with information that is heard
Paying attention in class
Short-term memory
Planning and organizing
If your child shows changes in learning ability, he or she can be assessed so you can create a plan to meet your child's needs. At your child's regular follow-up visits to the transplant center, doctors will monitor your child's development and watch for changes. See Returning to School after Transplant for more information.
Doctors will check your child's height and weight regularly after transplant to see if he or she is growing as expected. If your child does not grow at a normal rate, an endocrinologist (doctor who is a hormone specialist) can assess your child. Some drugs common after transpant can affect growth. If tests show your child's body is not making enough growth hormone, growth hormone therapy may help. If your child does not have the growth spurt that comes with puberty, treatment with sex hormone replacement therapy may be an option. Doctors are still learning more about who may or may not benefit from each kind of hormone therapy. Although some children do not grow as tall as expected, most grow to within the normal adult range.
InfertilityMost people treated with a bone marrow or cord blood transplant become infertile. The treatments your child receives before transplant and your child's age at treatment affect the chances he or she will be infertile. Before transplant, talk with your child and your child's doctor about this risk. Older children who have gone through puberty may be able to take steps to provide options for having a child in the future. Before transplant, older boys may be able to have sperm frozen. Older girls may be able to have eggs frozen. However, these methods are not an option for everyone and do not always work. You can ask your child's doctor whether these or other options are available for your child.
Your child will also need to know that not everyone who has a transplant becomes infertile. Some transplant survivors have gone on to have children. When your child is ready to think about these questions, encourage him or her to talk with a doctor, either with or without you present. You can get more information from the non-profit organization Fertile Hope at www.fertilehope.org.
Changes in memory or learning
For many children, transplant has no effect on learning. However, some children have changes in the ways they can learn or remember information. Children who are older at transplant have a low risk of such changes. The risk may be higher for very young children. [1, 2] The risk may also be higher for children who had disease in the central nervous system or had radiation treatments. Changes in learning can appear soon after transplant, but often do not surface until years later. For example, a memory problem may not appear until a child tries to learn multiplication tables.
If your child's learning is affected, you can work with the school to meet your child's needs. Watch for drops in your child's grades or increased feelings of frustration with school. Other signs you and your child's teacher can watch for include problems with:
Understanding what he or she reads
Needing much more time and effort to complete work than other children do
Math, such as remembering multiplication tables or organizing math problems
Remembering, understanding and using information that he or she reads or sees, while having an easier time with information that is heard
Paying attention in class
Short-term memory
Planning and organizing
If your child shows changes in learning ability, he or she can be assessed so you can create a plan to meet your child's needs. At your child's regular follow-up visits to the transplant center, doctors will monitor your child's development and watch for changes. See Returning to School after Transplant for more information.
Role of the Transplant Caregiver
Role of the Transplant Caregiver
If someone you love is undergoing a bone marrow or cord blood transplant (also called a BMT), you may feel you have been thrown into a new and sometimes frightening world of medical terms, test results and treatment choices. You will be called on to gather information, talk to doctors, stay by your loved one's side for hours and support him or her in many other ways. In other words, you are serving as a transplant caregiver.
Each transplant patient's needs are different. Each transplant caregiver will find his or her own way to meet those needs. What is the same for everyone is that a caregiver plays a vital role in the patient's treatment and recovery. Because a caregiver is so important, most transplant centers require a patient to have a caregiver to help them through the transplant process.
Most often, one person acts as the transplant patient's main caregiver. Sometimes, no one is able to play this role full time. Instead, a group of people can work together as caregivers. When a group shares the caregiving role, organization and communication are keys to success.
For a free, easy online tool to organize a community of family and friends who want to help, see Lotsa Helping Hands: http://www.marrow.lotsahelpinghands.com. With this private group Web calendar, people can see what help is needed and when, so everyone can pitch in to help make the transplant patient's life run more smoothly.
For one model of a way to organize a caregiving team, see www.sharethecare.org.
If someone you love is undergoing a bone marrow or cord blood transplant (also called a BMT), you may feel you have been thrown into a new and sometimes frightening world of medical terms, test results and treatment choices. You will be called on to gather information, talk to doctors, stay by your loved one's side for hours and support him or her in many other ways. In other words, you are serving as a transplant caregiver.
Each transplant patient's needs are different. Each transplant caregiver will find his or her own way to meet those needs. What is the same for everyone is that a caregiver plays a vital role in the patient's treatment and recovery. Because a caregiver is so important, most transplant centers require a patient to have a caregiver to help them through the transplant process.
Most often, one person acts as the transplant patient's main caregiver. Sometimes, no one is able to play this role full time. Instead, a group of people can work together as caregivers. When a group shares the caregiving role, organization and communication are keys to success.
For a free, easy online tool to organize a community of family and friends who want to help, see Lotsa Helping Hands: http://www.marrow.lotsahelpinghands.com. With this private group Web calendar, people can see what help is needed and when, so everyone can pitch in to help make the transplant patient's life run more smoothly.
For one model of a way to organize a caregiving team, see www.sharethecare.org.
Side Effects of Chemotherapy
The high doses of chemotherapy and TBI used in the preparative regimen can cause short-term side effects. (Patients who receive reduced-intensity transplants may have reduced side effects.) You may have some side effects as soon as you begin your preparative regimen. Some go away quickly after your preparative regimen stops. Others can last for a few weeks after you complete your preparative regimen and receive your transplant. Your transplant team will watch you for these side effects and treat them if they occur.
Common side effects that may begin in the first week after the preparative regimen include:
Nausea
Vomiting
Diarrhea
Lack of appetite
Common side effects that may begin in the second week after the preparative regimen include:
Mouth sores (oral mucositis)
Lack of appetite
Some of these side effects are made worse by drugs used to prevent a common transplant complication called graft-versus-host disease (GVHD). Your doctor may give you methotrexate or other drugs for this purpose. Although these drugs may make some side effects worse, they can work well to prevent GVHD, which can be a serious complication.
If you get these or other side effects, your transplant team can treat them to make you more comfortable. If needed, your doctor may give you morphine or other medicine to control the pain of mouth sores. Mouth rinses and careful tooth and gum care can also help reduce problems with mouth sores. The mouth sores and other side effects listed above usually begin to heal when your white blood cell count rises. This will happen when your transplant engrafts (the donated cells begin to grow and create new blood cells and an immune system).
Other common short-term side effects that can be caused by the chemotherapy in the preparative regimen are tiredness, hair loss and skin rashes. The tiredness and skin rashes caused by chemotherapy will improve when your transplant engrafts. People's hair usually begins to grow back 3 to 6 months after transplant.
Less common early side effects
There are also less common side effects that can appear in the first month after the preparative regimen. Some of these can be serious. The less common early side effects include veno-occlusive disease (VOD) of the liver, lung damage and damage to the heart muscle — cardiomyopathy. Some patients may also get other uncommon side effects.
Veno-occlusive disease
The preparative regimen can cause VOD in the first month after transplant. In VOD, the blood vessels in the liver swell and block the blood flow. As a result, the liver cannot remove waste products from the bloodstream. Symptoms can include pain in your upper right abdomen, weight gain and jaundice. There is no proven way to prevent it. If you get VOD, your transplant team can take steps to ease your symptoms, including:
Giving you red blood cell transfusions
Switching to drugs that are less harmful to the liver
Using dialysis to reduce fluids in your body if your kidneys are also affected
Giving you a low-salt diet
Giving you a drug that prevents blood clots, such as heparin
Lung damage
The chemotherapy in the preparative regimen can damage the lungs so that it is harder to breathe. The damage can range from mild to severe. Treatment depends on the amount of damage. A patient may be given oxygen, or in severe cases may be put on a ventilator to help him or her breathe. Steroids may be effective to treat the lungs for some patients. However, lung damage can be serious, and in some cases the damage is long-term. Your doctors may need to do tests to try to find out the cause of problems in your lungs. Infections can cause similar symptoms but may be treated differently.
Cardiomyopathy
Cardiomyopathy is a serious disease in which damage to the heart muscle makes the heart unable to work well to pump blood to your body. Cardiomyopathy is life-threatening, but it is rare.
Common side effects that may begin in the first week after the preparative regimen include:
Nausea
Vomiting
Diarrhea
Lack of appetite
Common side effects that may begin in the second week after the preparative regimen include:
Mouth sores (oral mucositis)
Lack of appetite
Some of these side effects are made worse by drugs used to prevent a common transplant complication called graft-versus-host disease (GVHD). Your doctor may give you methotrexate or other drugs for this purpose. Although these drugs may make some side effects worse, they can work well to prevent GVHD, which can be a serious complication.
If you get these or other side effects, your transplant team can treat them to make you more comfortable. If needed, your doctor may give you morphine or other medicine to control the pain of mouth sores. Mouth rinses and careful tooth and gum care can also help reduce problems with mouth sores. The mouth sores and other side effects listed above usually begin to heal when your white blood cell count rises. This will happen when your transplant engrafts (the donated cells begin to grow and create new blood cells and an immune system).
Other common short-term side effects that can be caused by the chemotherapy in the preparative regimen are tiredness, hair loss and skin rashes. The tiredness and skin rashes caused by chemotherapy will improve when your transplant engrafts. People's hair usually begins to grow back 3 to 6 months after transplant.
Less common early side effects
There are also less common side effects that can appear in the first month after the preparative regimen. Some of these can be serious. The less common early side effects include veno-occlusive disease (VOD) of the liver, lung damage and damage to the heart muscle — cardiomyopathy. Some patients may also get other uncommon side effects.
Veno-occlusive disease
The preparative regimen can cause VOD in the first month after transplant. In VOD, the blood vessels in the liver swell and block the blood flow. As a result, the liver cannot remove waste products from the bloodstream. Symptoms can include pain in your upper right abdomen, weight gain and jaundice. There is no proven way to prevent it. If you get VOD, your transplant team can take steps to ease your symptoms, including:
Giving you red blood cell transfusions
Switching to drugs that are less harmful to the liver
Using dialysis to reduce fluids in your body if your kidneys are also affected
Giving you a low-salt diet
Giving you a drug that prevents blood clots, such as heparin
Lung damage
The chemotherapy in the preparative regimen can damage the lungs so that it is harder to breathe. The damage can range from mild to severe. Treatment depends on the amount of damage. A patient may be given oxygen, or in severe cases may be put on a ventilator to help him or her breathe. Steroids may be effective to treat the lungs for some patients. However, lung damage can be serious, and in some cases the damage is long-term. Your doctors may need to do tests to try to find out the cause of problems in your lungs. Infections can cause similar symptoms but may be treated differently.
Cardiomyopathy
Cardiomyopathy is a serious disease in which damage to the heart muscle makes the heart unable to work well to pump blood to your body. Cardiomyopathy is life-threatening, but it is rare.
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