Treatment & Services
Bone Marrow Transplant
Arizona Oncology's hematology/oncology physicians specializing in bone marrow transplant, also called a stem cell transplant, bring extensive experience consulting with and treating stem cell transplant patients. The Cancer Transplant Institute is located at the Virginia G. Piper Cancer Center at Scottsdale Healthcare, which is a new program created to provide comprehensive, personalized care for patients with blood cancers such as leukemia, lymphoma and multiple myeloma. Patients will be seen in consultation at the Virginia G. Piper Cancer Center and undergo Stem Cell Transplant at Scottsdale Healthcare (Shea Campus). These transplants are performed in both an outpatient and an inpatient setting. Whether a patient is treated primarily as an inpatient or an outpatient depends on the type of transplant, the type of cancer, and on the individual patient and family needs. The Cancer Transplant Institutes provides complete care throughout the entire spectrum of a patient’s transplant process, from initial consultation services through to follow-up care after a bone marrow transplant (often called hematopoietic stem cell transplant).
Select the links below to learn more about Stem Cell Transplant:
What is Bone Stem Cell Transplantation (SCT)
Stem Cell transplantation is a highly advanced and specialized procedure that first uses chemotherapy, with or without radiation, at very high doses to eliminate cancer cells within the body. As a result of this intensive treatment, the patient’s bone marrow is rendered incapable of producing healthy blood cells from the stem cells that reside in the bone marrow. Stem cells are immature cells that give rise to white blood cells (which fight infections), red blood cells (which carry oxygen), and platelets (which prevent bleeding).
There are two types of bone marrow transplants. Autologous (where your own cells are used) and allogeneic (where a donor is required). In fact, for the majority of the autologous transplants we don’t even use bone marrow but instead collect cells from your bloodstream.
In an autologous transplant, very high doses of chemotherapy or radiation are used to kill the tumor cells in your body. The levels of therapy required to kill these tumor cells are often five to tenfold the regular chemotherapy doses and they also, as an unintended side effect, kill the cells that live in the bone marrow. The cells in the marrow contain the all-important blood stem cells that have the ability to form all of the blood types. These include the red blood cells that carry oxygen, the white blood cells that treat infection and the platelets that prevent bleeding. In addition, these stem cells are able to form themselves so that theoretically a single cell could reproduce the entire bone marrow after it is damaged. This may also be referred to as a stem cell rescue or stem cell support. In this situation, the important treatment for the cancer is the high doses of chemotherapy. The stem cells that are given back after the therapy is completed allow the “rescue” of the marrow which enables us to give the required high doses of chemo or radiotherapy.
It is important to know that these stem cells are not the ones that you often hear about on the news. These are largely limited to producing only the blood type cells listed above. Although they reside in the bone marrow, we rarely collect them from the marrow itself. Instead, we use the fact that after chemotherapy and certain medicines that the stem cells move into the bloodstream. We can then collect the cells from the bloodstream to be used later after the high doses of chemotherapy are given.
The second major type called an allogeneic transplant also typically involves very high doses of chemo or radiation therapy to kill the underlying cancer cells. In this situation, cells are collected from a donor and given back to the patient. These cells can also be collected from the bloodstream or bone marrow and in some cases from the umbilical cord blood. When these donor cells grow to form the new blood stem cells they retain some of the characteristics of the original donor. This is a true transplant of the blood and immune system from your donor.
Since these two forms are very different they also carry different risks and complications. The choice of which form of transplant you may require is often based on the type of cancer that you have, how you have responded and your general health. During your initial visit, your doctor will discuss with you which transplant is more appropriate as well as the risks and benefits to each approach.
Patient Services and Transplant Team
The Stem Cell Transplant team has extensive experience providing high-quality patient care. Our goal is to make sure every patient is educated throughout their whole treatment process. Because anxiety and emotional distress can lead to depression and fatigue, it is imperative for patients to process information and resolve issues. Addressing such components provides patients the opportunity to more effectively manage their illness and experience a better quality of life. Our patients are not alone. Battling cancer is a big enough challenge. We are with them every step of the way offering a range of specialty support services.
Coordinators – The transplant coordinators are involved in your care beginning with your first consultation with the transplant physician. They will coordinate the tests and procedures that are necessary before, during and after your transplant. They will also serve as liaisons between you and your insurance company to obtain authorization for the transplant and other care. They coordinate services with all members of the healthcare team to create a treatment plan that meets your healthcare needs.
Clinical Educators/Individualized Nurse Case Management (CNS) – CNS is responsible for the educational information for the patients and family members, as well as, the nursing staff. They facilitate patient-focused activities, such as caregiver classes, support groups for BMT patients and their families and therapy programs. The CNS is also responsible for program development, such as overseeing the collection of “Quality of Life” data.
Dietary/Nutritional Counseling Services – Dedicated dietician who works closely with patients and families to determine eating habits and then provide information about what foods are appropriate during the BMT process. The dietician discusses the low bacteria diet that will be required during the hospital stay, as well as calculates individual nutrition needs, evaluate the effect of your medical condition on nutrition needs, and helps patients make appropriate food choices before and after transplant. Once you are discharged from the hospital, the dietician helps patient and caregiver plan the right food choices.
Financial Counseling Services – The financial aspect of dealing with cancer can be complex and overwhelming. Our Patient Benefit Representatives (PBR’s) specialize in transplant services. They are dedicated to serving the individual needs of every patient. PBR’s, who are an extension of our Business Office, provide guidance through financial issues, and they are available to address patients’ questions and concerns about the cost of treatment. They also handle insurance inquiries and verifications. For patients whose insurance coverage is inadequate, or if the insurance company chooses not to cover services, our PBR’s can help identify assistance programs that may help in meeting financial obligations.
Pharmacy – Your pharmacist is a valuable member of your healthcare team with a wealth of information about the medicines you take. The basic duties of a pharmacist are to inform patients how to correctly use the medications. As a transplant recipient, you will get to know your pharmacist very well. Pharmacists are experts in medicine and its side effects and are able to assist with your medication concerns.
Social Worker – Every transplant recipient is assigned to a social worker who will complete an assessment to ensure your needs are met prior to the transplant. The social worker role may have some variation at each center. Social work services will not only be available to you, the patient but also your family and to the donor. The social worker provides support, education, and counseling to reduce stress during the transplant process. Social workers usually have extensive knowledge of the community services provided to transplant recipients. The social worker acts as a sounding board so you and your family can feel comfortable having open discussions with him. The social worker may also be able to advise on Medicare, Medicaid, and other insurance-related issues.
Disease Types commonly treated with Transplant
- Leukemias (acute and chronic)
- Non-Hodgkin’s Lymphoma
- Hodgkin’s Disease
- Multiple Myeloma
- Aplastic Anemia
- Myelodysplastic Disorders
- Certain Solid tumors (Germ cell, neuroblastoma)
If an allogeneic transplant is an option for the patient, we often look first to a patient’s brothers and sisters to find a donor. The area that determines if you might match is inherited from the parents in an area on Chromosome 6 called the major histocompatibility complex. We use testing of your HLA (human leukocyte antigen) to see if you match your sibling. Since it is inherited from the parents and there are 2 copies of each gene, there are a total of four potential HLA types that you can be. This means that each sibling has a one in four chance that they might be a match.
We can test this using blood or now using a swab of the cheek (just like on C.S.I.). It usually takes about 2 weeks to find out if you are a match. If you don't have an available match from a sibling than we look to the National Marrow Donor Program (NMDP) which has over 10 million people on the registry. There is a good chance we will be able to find a suitable donor between your family and the NMDP. Many people ask if children or parents can be donors. Although there is some early data on using these types of donors since they are not very closely matched, it carries with it many more dangers and at present, is only suitable if someone is on a clinical trial.
To learn more on how to become a donor or how you are matched with a donor please visit www.nbmtlink.org
FACT Accreditation and National Marrow Transplant Program (NMDP)
Arizona Oncology’s physicians are part of a stem cell transplant service that is one of three in the state of Arizona and 135 nationally. The Cancer Transplant Institute at the Virginia G. Piper Cancer Center is accredited by FACT, the Foundation for the Accreditation of Cellular Therapy, for both autologous and allogeneic adult transplants. It is also an accredited bone marrow collection facility and processing laboratory. FACT is the only accrediting organization that addresses all quality aspects of cellular therapy treatments: clinical care, donor management, cell collection, cell processing, cell storage and banking, cell transportation, cell administration, cell selection, and cell release. FACT accredited programs have met rigorous standards, as defined by the leading experts in the field of cellular therapy.
The Cancer Transplant Institute at the Virginia G. Piper Cancer Center is also a member of the National Marrow Transplant Program (NMDP) which enables it to perform unrelated donor transplants. To qualify as an NMDP program you must meet strict national standards to meet the demands of this complex form of transplantation.
Cancer Transplant Institute
Virginia G. Piper Cancer Center
10460 N. 92nd St., Suite 200
Scottsdale, AZ 85258