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Wednesday 19 March 2014

Stem Cell Transplants for Blood Cancers

Stem cell transplants have become important weapons in the fight against certain blood cancers, such as multiple myeloma, non-Hodgkin's lymphoma, Hodgkin lymphoma, and leukemia. A stem cell transplant may help you live longer. In some cases, it can even cure blood cancers.
About 50,000 transplantations are performed yearly, with the number increasing 10% to 20% each year. More than 20,000 people have now lived five years or longer after having a stem cell transplant.
Here's how it works: The stem cells in healthy bone marrow produce blood cells, including the white blood cells that are crucial to your immune system. Blood cancers themselves damage your bone marrow, and so do chemotherapy and radiation treatments for the cancers. A stem cell transplant lets new stem cells take over from your damaged marrow so your body can produce healthy, cancer-free blood cells.
Your doctor may want to use stem cells taken from your own blood, or stem cells from a donor. If you use your own stem cells, your blood will be drawn when your cancer is not active. If you use a donor's cells, your doctor will first need to find a matching donor. Either way, you will have chemotherapy and/or radiation beforehand. This will kill the cancer cells and destroy your damaged stem cells so the transplanted stem cells can take over.
If you use your own cells, you may be able to have an outpatient stem cell transplant. You need to have no other serious medical conditions, have a caregiver who can monitor you at home, and live within an hour of the hospital. Your home environment must be carefully prepared, and you must wear a mask when going out.
Here's what to expect from the transplant process.

Before the Stem Cell Transplant

  1. You or the donor will get injections of special medicines four or five days before the blood draw. These medicines move blood-forming stem cells from your bone marrow into your bloodstream.
  2. Your blood or the donor's will be drawn. The stem cells from your or the donor's bloodstream will be separated from the rest of the blood and frozen.
  3. You will have "conditioning treatment." This will be either high- or low-dose chemotherapy and/or radiation. Its purpose is to kill the cancer cells and destroy your own stem cells -- destroying your immune system in the process -- so the transplanted stem cells can take over.

During the Stem Cell Transplant

  1. You will have an infusion of the stem cells. You'll sit in a comfortable chair for several hours as the infusion is given through a central line (a surgical port in your neck).
  2. Nurses will monitor you. They will check to be sure you are not developing fever, chills, hives, or a drop in blood pressure.
  3. You might have mild side effects, including headache, nausea, flushing, or shortness of breath.

After the Stem Cell Transplant

  1. Your new immune system starts to work.After two to four weeks, the new stem cells graft to your bone marrow and start to make new white blood cells. Next, your body starts making platelets, then red blood cells.
  2. If you received donor cells, you will get antibiotics and anti-rejection drugs to help your body accept the transplanted cells. You may also need transfusions of red blood cells and platelets as well as intravenous nutrition.
  3. You must stay in a germ-free environment for the first few weeks. If you have a transplant with donor cells, you will probably stay in the hospital for about a month until your new immune system starts working. You will need filtered air and your visitors must wear masks.
  4. You will make regular visits to the outpatient clinic for six months. The transplant staff will test your blood or bone marrow for levels of healthy blood cells and check for any complications. After that, your own doctor will continue to care for you.

During Recovery From Your Stem Cell Transplant

You'll feel tired for the first few weeks. It may be several months before you can resume your normal schedule. About two months after the transplant, your doctor will draw blood and may take a sample of bone marrow from your hip to see that you are producing all types of blood cells. The bone marrow will also show which cells are being formed, yours or, preferably, the donor's. This is known as chimerism. Your doctor will also want to see that you have no major complications.

Making the Decision: Next Steps

  • Arrange an appointment with your doctor to talk about possibilities.
  • Meet the staff at your hospital and check out its statistics on stem cell transplants.
  • Consider the impact that transplantation and recovery might have on your job, if you work, and your home life.
  • Ask family members if they could help during recovery.
source:webMD
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Healthy Eating When You're Sick

Eating healthy meals isn't easy when you don't feel well, especially if you have a serious or chronic illness. You may be too tired to prepare food for yourself. Medicines may make food taste strange or unpleasant. Mouth sores or swallowing problems can make eating difficult. Or nausea, which is a common symptom and a common side effect of some medications, may make food the last thing you want to think about.  
"Fortunately, there's a lot you can do, even when you're not feeling well, to get the nutrition you need," says Veronica McLymont, PhD, RD, director of food and nutrition services at Memorial Sloan-Kettering Cancer Center.

Lack of Appetite

Eat smaller meals more frequently through the day than you do when you're healthy. "We tend to eat with our eyes," says Sarah Rafat, RD, senior dietitian at MD Anderson Cancer Center. "Sitting down to too big a meal can seem overwhelming if you don't have much of an appetite." Make a list of comfort foods that you love and have one or two on hand for when you feel like eating. Also keep nutritious snacks handy, such as nuts, carrot sticks, or yogurt.

Mouth Sores, Dry Mouth, or Trouble Swallowing

Avoid foods that require a lot of chewing. Puree or grind foods like meat and vegetables to make them easier to eat. Liquid foods such as soups and smoothies are also good options. "Real foods are always the best choice," says Kim Jordan, RD, director of nutrition at Seattle Cancer Care Alliance, part of the Fred Hutchinson Cancer Research Center. "But if you’re having serious problems eating and swallowing, talk to your doctor about liquid meal replacements." For dry mouth, try chewing gum or sucking on hard candies like lemon drops, which stimulates saliva production.

Nausea

Choose bland foods. Eat smaller meals more often during the day than you would when you are healthy. Eat slowly. Hard candy, peppermint, and ginger may ease nausea. If nausea persists, talk to your doctor. An anti-nausea medicine may help.

Fatigue

When you're sick, you may feel too tired to make a meal. Stock up on prepared foods that you can easily pop in the microwave, such as frozen lasagna or pot pies. Keep nutritious snacks on hand such as nuts, sliced vegetables, hardboiled eggs, whole grain breakfast cereal, or yogurt. Eat your biggest meal at a time when you have the most energy.

Diarrhea

Diarrhea is a common symptom and a side effect of some medicines. Eating soft, bland foods and avoiding greasy foods can help. Drink plenty of water or other fluids, since diarrhea can quickly dehydrate you. One way to replace electrolytes is to drink a sports beverage diluted with water.

Constipation

Opioid pain medicines and certain other treatments often cause constipation. To help prevent and treat constipation, eat foods high in fiber, such as apricots, prunes, applesauce, and whole grain breakfast cereals. Getting up and walking can also help get your digestive tract moving.

Unwanted Weight Loss

"If you're losing weight when you shouldn't, your top priority is taking in more calories," says McLymont. Help yourself to foods you love, including high-calorie foods like milkshakes and desserts. Eat as often as you can throughout the day. Snack on high-energy foods such as nuts, seeds, cheese slices, and hardboiled eggs.

Unwanted Weight Gain

Some commonly used medicines can also make you gain unwanted weight. These include:
  • Alpha-blockers and Beta blockers for regulation of blood pressure
  • Anticonvulsants for epilepsy or other neurologic symptoms
  • Antidepressants, certain ones such as Elavil, Endep, (amitriptyline), Eskalith, Lithobid (lithium carbonate), and Zyprexa (olanzapine)
  • Insulin
  • Steroids like prednisone for arthritis and similar conditions

Falling Short on Nutrients

If you're having real trouble eating a balanced diet, you may benefit from taking a vitamin and mineral supplement. Talk to your doctor or a dietitian before taking dietary supplements, especially if you take medicines for a serious health condition. Some supplements can impact the effectiveness of medicines.
source:webMD