Stem cell transplants

Stem cell transplants in Denver

Bone and marrow transplants provide greater possibilities for blood cancer treatment outcomes.

If you're experiencing blood cancer, the team at Colorado Blood Cancer Institute is equipped to perform both inpatient and outpatient stem cell transplants. Transplants we offer include autologous and allogenic transplants.

Conditions that may require a stem cell transplant

Our center offers treatment for a variety of hematological diseases and associated disorders, such as:

• Acute lymphocytic leukemia (ALL)
• Acute myeloid leukemia (AML)
• Amyloidosis
• Aplastic anemia
• Chronic lymphocytic leukemia (CLL)
• Chronic myeloid leukemia (CML)
• Hodgkin lymphoma
• Multiple myeloma
• Multiple sclerosis (MS)
• Myelodysplastic syndrome (MDS)
• Non-Hodgkin lymphoma (NHL)
• Paroxysmal nocturnal hemoglobinuria (PNH)
• Rheumatologic diseases
• Scleroderma
• Testicular cancer

Transplant services we provide

If you have blood cancer, a blood or marrow stem cell transplant can be necessary for effective treatment. We may also recommend this course of action if you have an autoimmune disorder, such as MS or scleroderma.

Basics of blood and marrow transplants

The transplant process can be complex, but our specialized hematologists will help you navigate any challenges. As a member of the HCA Healthcare Sarah Cannon Cancer Network, we can provide you with access to numerous critical resources that give you a better understanding of the road you're on.

There are different types of blood and marrow transplants, but all involve the infusion of hematopoietic stem cells. This type of cell is found in bone marrow, and has the ability to mature into healthy blood cells. Depending on your type of cancer, your bone marrow transplant specialist may use your own stem cells (autologous transplant) or stem cells collected from a donor (allogenic transplant), then infuse them into your bloodstream. As this happens, they naturally migrate into the bone marrow, replicating and becoming healthy red blood cells, white blood cells and platelets.

After your stem cell transplant, you will remain under close observation. Ideally, your transplanted stem cells will continue to multiply and produce blood cells to create a healthy immune system.

Sibling stem cell donation

Finding a suitable donor for an allogenic transplant is accomplished through the process of human leukocyte antigen (HLA) typing. People often assume that if their blood type matches, their HLA types must also match, but this is not the case. HLA typing is a molecular laboratory test that examines DNA structure in blood samples.

Sibling donor typing is when a sibling is tested to determine if they are a suitable donor match. Typically, during this testing, a sibling's HLA markers are examined. The donor match will be facilitated through the transplant coordinator. You will then need to make a plan to come to our facility to have blood drawn. For siblings living outside the Denver metro area, there are home kits for the testing. The cost of the HLA typing itself will be covered by the transplant recipient’s insurance.

If we find that no siblings match, there is always the option of an unrelated donor. Since your typing will be complete, we will run a preliminary search of the National Marrow Donor Program's unrelated donor registry to try and find a match. This is free of charge and gives us an idea of the potential availability of unrelated donors. If this route is most suitable, we will look more in depth at donors on the registry and have samples of their blood sent to our laboratory.

Each donor, related or not, undergoes a physical exam, health history assessment and lab work-up to assess their suitability as a donor. At times, the findings from this workup will make a person not eligible to donate. Some of the findings include the presence of hepatitis, HIV and blood disorders.

Donation process

Depending on whether the physician wants to use blood or marrow stem cells, the actual donation process for the related donor requires that they be in Denver for seven to 10 days. Marrow stem cells are surgically "harvested" from the pelvic bones, while blood stem cells are collected through a process called apheresis.

Donated stem cells are most often given to the recipient on the same day they are collected from the donor. Fresh stem cells are viable for 48 hours. In the event all of the collected stem cells are not needed, the excess cells will be cryopreserved for future use.

Before a transplant

Deciding to have a transplant is a significant moment for you and your loved ones. We understand that planning for such a procedure is important, and are here to support you along the way. After your diagnosis, you'll likely have questions, so we'll address any and all concerns during your initial consultation.

Pre-transplant testing is integral to this part of the process, in order to determine the best care plan moving forward. Depending on the type of condition you have, tests may include X-rays, computerized tomography (CT) scans, bone scans, blood tests and urine tests.

Our program offers allogenic and autologous transplants on both inpatient and outpatient bases. Factors that determine whether you receive an inpatient or outpatient transplant include the language in your insurance policy, your diagnosis, your performance status and whether you have a caregiver. Also, if you are on blood thinners, this will need to be discussed with your transplant coordinator.

Find out how you can be a donor in the future.

Central venous catheters (CVC)

Throughout the transplant process, you will need a CVC, a tube that is placed in a large vein in your chest with the internal tip extending as far as your heart. The catheter is inserted by a doctor using IV sedation, and will be used to draw blood, as well as administer chemotherapy, medications, IV fluids and blood products.

For autologous transplants, this catheter will also be utilized for stem cell collection. If you already have a CVC when you start the transplant process, your transplant physician will evaluate whether you can use your existing catheter or need a new one.

Transplant consultation

During a consultation, your transplant physician will review the history and characteristics of your disease to determine if a transplant is the best treatment option at this time. Your oncologist and transplant physician must carefully consider the benefits of transplant versus the risks. During your initial consultation, you will receive detailed information about transplants, as well as other potential treatment options.

Your care team

Stem cell transplants require a dedicated team of experienced healthcare professionals. Your team may consist of your transplant physician, consulting physicians, nurses, transplant coordinator, pharmacist, laboratory technicians, social workers, psychologists and experienced caregivers.

After your transplant, your care team will monitor your blood cell counts and work to protect you against the risks of infection. You will see your care team frequently to ensure your blood levels remain healthy and you are doing well.

Transplant nurse

Throughout your transplant, you will be cared for by dedicated transplant nurses who manage your care in conjunction with other members of the transplant team. The transplant nurses administer chemotherapy and stem cells, while assessing and managing daily symptoms associated with transplantation. Together with the transplant physicians and nurse practitioners, transplant nurses are here to make you as comfortable and safe as possible while in our care.

Transplant nurse coordinator

The transplant nurse coordinator is your guide in preparing for your transplant. This nurse has special training and experience in stem cell transplantation, as well as preparing individuals to undergo this procedure. They are also your primary contact for questions and concerns as you navigate the transplant process. Primarily, transplant nurse coordinators work to ensure all necessary components of your pre-transplant workup are completed and reviewed so you may proceed safely to transplant. These may include consultations, scans, blood work and pre-transplant education.

After a transplant

The road to recovery doesn't end with the transplant itself, so our long term follow up (LTFU) department works to support you even after you leave our facility. The goal of this multidisciplinary department is to function as a partner for you and your caregiver, ensuring you receive support and monitoring for any health issues that may arise from the transplant. These can include:

• Endocrine issues
• Feelings of depression or anxiety
• Infectious diseases
• Iron overload in your blood
• Potential complications, such as graft vs. host disease (GvHD)
• Reactions to medications

We also offer recovery care through counseling and peer support. This includes:

• Caregiver emotional support programs
• Clinical care counseling
• Connections with survivors and previous transplant recipients
• Day-to-day nutritional care
• Licensed therapists

During your post-transplant recovery, you should have routine wellness workups with your primary care physician. You should also inform your transplant care team if you require dental work or develop cataracts as a result of receiving total body irradiation (TBI) or taking steroids.

You can reach out to the LTFU team via email for additional information.

GvHD clinic

Following a stem cell transplant, bone marrow or stem cells from a donor attack the recipient. This is what is known as GvHD. The goal of the GvHD clinic is to evaluate and treat adults who have undergone an allogeneic transplant and give them a dedicated setting to receive proper care from specially trained doctors and nurses. This team is prepared to treat those who have contracted any form of GvHD from transplants performed at both our hospital and other hospitals.

Recovery for allogenic transplants

Following completion of an allogenic transplant, close monitoring will be crucial, as you will need to be seen at the clinic one to two times per week for around the first four months. Particularly if you have undergone an allogeneic transplant, you should expect the recovery period to last at least a year. Depending on your level of overall health and how the procedure affected you, it may last longer.

Recovery for autologous transplants

The recovery period for an autologous transplant is usually faster than an allogenic transplant. In the first thirty days following an autologous transplant, you will likely still feel fatigued as you recover. The frequency of visits to your autologous transplant physician will vary depending on your specific medical needs. Most people are able to return to their primary oncologist at this time and only meet with our team as part of the long-term follow-up program.