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Blood & Marrow Transplant Archive Questions

Below are Dr. Yanovich’s answers to Blood & Marrow Transplant questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 51.

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Q : 1

I've read that there are a number of different viral infections that can occur following a transplant. How frequently can one expect to be tested for these types of infections? What sort of test is involved and will it require frequent blood draws?

Following a discharge from the inpatient unit, transplant patients are followed very closely in the outpatient clinic. Most patients will have several blood studies at least once a week at the beginning, including a very sensitive test to attempt to diagnose reactivation of the cytomegalovirus. Other studies including urine, stool and nasal secretions are only done when indicated.

Q : 2

My brother has CML and I want to be tested to see if I am match as a bone marrow donor. How long does it take to get these results?

First, you would have to make an appointment at our center. It takes at least four weeks to receive the results from the lab at which time we would notify you. Often, siblings are only a half match for bone marrow donation.

Q : 3

Is there any contraindication for a 60 year-old-patient who has had chemotherapy to have a colonoscopy before an autologous stem cell transplant? Is a colonoscopy required before the transplant?

If the patient's blood counts are good, there is no contraindication. A colonoscopy is not an absolute requirement before an autologous SCT, but if the patient did not have one previously, it is a good idea to do it to make sure the patient does not have colon cancer or a pre-malignant lesion. In addition, some insurance companies require the test for patients older than 50.

Q : 4

My husband has AML and needs a donor transplant, but is now having some cardiac issues. Will his heart working at only 30-35 percent negatively effect his ability to have a transplant?

He will only be able to receive a reduced intensity conditioning regimen prior to the donor stem cell transplant, which could increase his chances of relapse after the transplant.

Q : 5

I am interested in learning what the length of antiviral prophylaxis is for varicella/herpes zoster following autologous HCT.

In most patients, we stop the prophylaxis in the first couple of months post-transplant.

Q : 6

If you are a kidney transplant recipient, can you still donate bone marrow?

No, it is not recommended as the kidney recipient has been on immunosuppressive therapy.

Q : 7

Should a person over 60 who is about to have an autologous cell transplant have a colonoscopy performed before or after the transplant? I've been told that the PET scan alone will not be sufficient to find a Colon Cancer. Is that true?

Yes, PET scans can have false negative results and could miss a curable colon cancer.

Q : 8

Is a bone marrow transplant (BMT) the only solution after leukemia relapses? Are there drugs that can control it? Is BMT safe? Are there any organizations that help patients financially?

BMT could be associated with significant complications, including death, but for patients with relapsed leukemia it is likely the best treatment. I am not aware of any organizations in the US which help financially the patients.

Q : 9

My 30-year-old daughter has congenital diamond/blackfan anemia and requires two units of packed red cells every two weeks. She is now is suffering from hemachromatosis and is taking two chelation drugs. Her doctor recommends bone marrow transplant. My concern is, what happens if the transplant fails?

If the transplant is rejected by the patient, it is possible her marrow could go back to baseline. It is also possible she may start requiring more frequent transfusions of red cells and possible platelets.

Q : 10

My ex-husband had an autologous bone marrow transplant in 1989 for non-Hodgkin's lymphoma. He was informed last week that he needs another transplant. Is it possible to have two transplants? What about chemo and radiation -- I thought those were cumulative.

The cumulative effect is well known for radiation therapy and some chemotherapy agents, which are seldom used during the transplant. Second transplants can be safely done using a chemotherapy only protocol with or without limited radiation therapy to areas of recurrent disease.

Q : 11

My husband has mantle cell lymphoma. Can you tell me what research shows in doing stem cell transplants from stem cells retrieved from bone marrow after two hyper-CVAD chemo treatments and one CHOP treatment? Is this considered experimental?

Autologous stem cell transplantation for mantle cell lymphoma in first remission is not considered experimental. The available data indicates that the transplant improves disease-free survival rates as compared to conventional chemotherapy. However, with the use of post-transplant maintenance therapy, the preliminary data also suggests it will improve overall survival.

Q : 12

I just registered with the National Marrow Donor Registry. After donating, I would be very interested in eventually meeting the recipient. What is UMMS' policy on donors and recipients meeting each other?

The policy is mandated by the National Marrow Donor Program. If the patient and the donor are in the United States, they could meet 1-year post-transplant, as long as both parties are interested in meeting. If the donor or the patient are out of the country, then they will have to wait 2-years, before a meeting is allowed.

Q : 13

My husband has relapsed Burkitt's lymphoma. We have not been able to find a 10/10 stem cell match. Our doctor has encouraged him to consider a haplo match using a sibling who is 6/10. We looked into haplo previously and decided against it because of the risk. When he relapsed this time, our stem cell doctor asked us to reconsider because of a new protocol developed at Johns Hopkins. However, she told us that there were additional data about success using myeloablative regimens with haplo stem cell transplants. My husband really wants to see some data that supports the success of haplo using the new protocol. He is trying to make a decision on whether or not he is willing to accept a haplo transplant. Any help you can provide would be greatly appreciated.

At our institution we are only performing haplo transplants for patients in remission. There are only few studies published with patients with NHL (most of them low-grade or intermediate grade); if the patient achieves a remission with the myeloablative conditioning regimen, the patient could have a reasonable possibility of achieving a long-term remission. Based on the few reports available, it is impossible to give you a percentage.I am sorry I was not able to be more helpful and I wish your husband success with his treatment.

Q : 14

Is it illegal to sell bone marrow? If not, do you know where I can sell mine?

In this country, it is illegal to sell any organs, including bone marrow to be given to a patient.

Q : 15

I am a 40 year old male who underwent an allogeneic bone marrow transplant for high risk leukemia about 7 years ago. I returned to work two years later, but needed to be accommodated in an area of low risk for contact with communicable diseases. My specialist continues to identify a need for limited contact. I was speaking with a nurse who said that nurses who had similar procedures had been placed in low risk areas as well, but that a study had been done indicating that there was no need for this type of restriction after a period of time post transplant. Are you aware of any such study and if so, could you identify who did it, or please provide your thoughts on the issue?

Generally, patients are able to resume their normal lives once they have been off any anti-rejection medications for at least 2 years, have no chronic GVHD, have reasonable immunoglobulin levels and T-cell numbers and have had all of their vaccine boosters completed.

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