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How do I contact the program?
To make initial contact with our program, call our program's toll free number, 800-944-8220, and ask for one of our Patient Coordinators. They are available from 8 a.m. to 5 p.m. (CT) Monday through Friday. After hours, please leave a message on the answering machine.
If you need to reach a transplant program physician, call the transplant inpatient unit, 319-356-3330. You may also call University of Iowa Hospitals and Clinics operator, 319-356-1616, and ask to speak with the fellow physician on call for hematology and oncology.
How can I be referred to your program?
The first step is to ask your physician to contact us. Because your physician has information crucial to completing our evaluation of your case, we strongly recommend you ask your physician to make the initial contact. We work with your physician to verify your disease can be treated with stem cell transplantation at our center. Through your physician, we make arrangements for an initial consultation visit to evaluate you and discuss your transplantation option.
Patients may call directly and self-refer.
How many transplants has your program done?
The Adult Blood and Marrow Transplant Program at UI Hospitals and Clinics has treated more than 1,300 adult patients with stem cell transplantation since our program began in 1980. Approximately 650 patients have been transplanted by using stem cells from someone other than the patient. An equal number of patients have been treated by using their own stem cells. Of those who received donor cells, more than 240 patients received their stem cells from an unrelated donor. We performed our first stem cell transplant in 1981. At present, approximately 120 to 140 adult patients are transplanted annually.
What are the differences between bone marrow transplantation and blood stem cell transplantation?
The single most important difference is the source of the stem cells that give rise to mature blood cells in our blood stream. Bone marrow transplantation uses marrow-derived stem cells that live in our bone cavity. Marrow stem cells used in transplantation are obtained from the donor by removing a portion of the liquid marrow from the hip bone using a needle. This procedure is done in an operating room and requires some form of local or general anesthesia.
Blood stem cell transplantation uses stem cells circulating in our blood stream that originate from the bone marrow. People do not have enough stem cells in their circulation to provide the number needed for a transplant. For a person to donate blood stem cells, we need to increase the number of cells circulating in the body. We do this by injecting the donor with a drug called Filgrastim subcutaneously or just under the skin. Filgrastim is a stem cell growth factor medication that increases the number of stem cells released from your marrow into your blood stream. These cells can then be collected from your veins using a process called apheresis. The injections of Filgrastim take place for four or five consecutive days prior to the donation. The apheresis procedure is similar to other blood donation procedures like donating platelets.
Clinically, we have learned that the use of blood stem cells has several advantages over the use of bone marrow cells. Transplanted blood stem cells start to produce new white cells and platelets faster than transplanted marrow cells. This is important because transplant patients are susceptible to life-threatening infections and bleeding until their white blood cell and platelet counts return to normal levels. However, blood stem cells contain a much higher number of lymphocytes, a class of immune cells that may recognize the recipient's body as different from the donor's body. This condition is known as graft-versus-host disease. The risk of graft-versus-host disease may increase in patients who are transplanted with blood stem cells. Therefore, the selection of either marrow cells or blood stem cells is carefully considered at the initial stage of transplantation. For patients receiving their own cells in transplant, blood stem cells are most commonly chosen because there is no adverse reaction to one's own body. A great deal of research is currently underway to determine which type of transplant method is best suited for transplants involving young patients, older patients, and patients receiving related or unrelated donor stem cells.
Are there physical conditions that may disqualify me from having a transplant?
Certain pre-existing problems could increase the chances of significant toxicity during or after the transplant. Because of this concern, each transplant candidate will be given a series of tests to help our physicians determine if the patient may move forward towards transplant. In general, these tests involve determining the health of your heart, lungs, kidneys, and liver.
How do I know if I have sufficient financial coverage for a stem cell transplant?
We encourage you to contact your insurance carrier. Insurance companies vary in their coverage of transplantation and in their contract with UI Health Care. Your case manager with your insurance company can tell you what is covered and whether you can be treated at UI Hospitals and Clinics. People who are Iowa residents may also be eligible for benefits from the State of Iowa. We encourage all of our patients to work closely with our social worker and patient coordinator to determine if they have sufficient coverage for transplantation.
How long can I expect to be in the hospital for my transplant?
If your experience is like most, you will spend four or five weeks in the hospital for your transplant. During the first eight to nine days you undergo radiotherapy and/or chemotherapy to prepare your body for transplant. Your new stem cells will then be infused. The next two weeks are a time of recovery as the new white blood cells begin to grow and circulate in your body. The last one or two weeks are a time of physical recovery as your body gains strength and your new immune system continues to develop.
The exact time for discharge is determined by an adequate white blood count, being able to take some oral medications, being able to ingest adequate amounts of fluid, and being able to provide a significant amount of your own care outside of the hospital. Whether you return immediately to home or remain in Iowa City following discharge depends on where you live, the availability of medical care, and your general medical condition.
What should I bring with me for my hospital stay?
Keep comfort in mind. Bring comfortable, loose fitting clothing, your favorite comforter, and some personal items such as your favorite pictures, books, CD or DVD player, etc. You are welcome to bring your personal computer with you.
My family wants to stay close to me during my hospitalization. Is there a special place for my family to stay? LINIK TO LODGING ON GUEST SERVICES
We understand the importance of being close to a loved one during a hospital stay. The Helen K Rossi Volunteer Guest House is a 14-room hospitality house located within the hospital for adult patients and their families. Guests are eligible to stay while the patient is receiving medical treatment at UI Hospitals and Clinics.
Motels in Iowa City have a special rate for long-term stay for the family. Many motels offer free shuttle service to and from the hospital. Our social worker will be happy to work with you to identify the best arrangements for your family.
What are the first signs that my transplant has been successful?
A noticeable rise in your white blood cell count is the first sign that your new stem cells have taken hold and are beginning to make new blood cells. This usually happens about three weeks after you received your new stem cells. This is the first sign of engraftment. Your white cell count will continue to rise and your platelet count begins to rise.
How long will it take for my immune system to recover?
Once discharged from your initial hospitalization, you will need time at home to continue to regain your strength and to let your immune system mature. The development of your new immune system is a slow process. Most people who are about six months out from an autologous transplant will have regained approximately 50 percent of the immune power of a normal immune system. Recovery of the immune system for patients who have had an allogeneic transplant may be delayed for 12 to 36 months. People who are required to take medications to control graft- versus-host-disease may continue to be susceptible to infections.
We advise you to take special precautions along with several preventive antibiotics during the first six to 12 months following your transplant. During the early phase of recovery, you are vulnerable to infectious complications. You are more susceptible to catching illnesses from other people. We advise you not go to places where you may run into large crowds. When you are one or more years out from your transplant, your immune system should eventually be able to protect you reasonably well from infections.
How long after transplant before I can return to my normal activities?
People who received their own cells in an autologous transplant are usually able to return to work or their normal activities in approximately six months. People who received donor cells in an allogeneic transplant are usually able to return to work or their normal activities in 12 or more months.
After I am discharged from the hospital, I would like to have minor problems that may arise treated at home as much as possible. How do I arrange this?
There are certain circumstances that may be handled at home by well-trained visiting nurses such as daily nutritional fluid, daily antibiotics, dressing changes of the central line on your chest, or blood product transfusion. Let our social worker know and we will contact your insurance company and home health care agencies to learn if this is an option for you.
I heard taking drugs that decrease fever such as Tylenol or Advil is not a good thing to do within a year after my transplant. Why?
When you have fever within a year after your transplant, we need to know if your fever is being caused by an infection. A fever is an important sign that an infection may be present. Drugs such as Tylenol or Advil may decrease a fever or prevent your body from having a fever even though an infection is present. By not taking these drugs, you are allowing your body to give you the warning signal you need. In fact, the simple presence of a fever may be the only sign of a catastrophic infection in your body.
The first thing you need to do if you develop a fever is to contact your physician or transplant physician immediately. Our Adult Blood and Marrow Transplant Program has a physician available 24 hours a day to respond.
I had chills after I flushed my central venous catheter. What should I do?
If you develop chills after you flush your central venous catheter, you need to stop flushing your line any further and contact your physician immediately. Developing chills after flushing your line could potentially indicate the presence of a line infection.
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