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Cancer patients usually have to make some lifestyle adjustments to accommodate their treatment. That could mean anything from taking time off to recover from surgery to waking up early to get to chemotherapy infusions before heading in to work.?

Everyone¡¯s accommodations will look a little different, depending on the type of cancer they have, how advanced it is and their individual treatment plan.?

But what if you need a stem cell transplant to treat leukemia, lymphoma, myeloma or some other blood disorder??

Here are four suggestions to help you prepare for that procedure.

Know your stem cell transplants to manage your expectations

Stem cell transplants replace damaged or faulty blood cells with healthy cells. They do this by ¡°rebooting¡± the immune system with an infusion of new stem cells after the old ones have been destroyed (along with cancer cells) by chemotherapy. All stem cell transplants fall into one of two categories:?

• Allogeneic stem cell transplants use cells from a matched donor; these could come from a family member, umbilical cord blood or a completely unrelated individual.??
• Autologous stem cell transplants use your own cells.

Some patients think they can move forward with a transplant right away, even if they need a donor¡¯s cells. But that¡¯s not always the case.?

Even in the earliest stages of donor identification, there¡¯s a lot of waiting to find out if someone is a good match for you. Then, you have to find out if they are still willing and able to donate, as well as how soon they can have their stem cells extracted.

A lot of people who register for the are young college students with class schedules to work around. So, you might have to wait a few months until they get time off around the winter holidays, spring break or summer vacation.?

You¡¯ll need a place to stay

No matter which type of stem cell transplant you receive, you¡¯ll need to be isolated in the hospital for at least 30 days after the infusion. This is to protect you while the new cells engraft and start rebuilding your immune system.?

It can take a while for your immune system to bounce back completely after a stem cell transplant. So, you¡¯ll likely be asked to remain close to the hospital for at least a few more weeks ¡ª if not months ¡ª after you¡¯re discharged. This is so you can get back to the hospital quickly if you develop a fever, an infection or any other complication.?

If you¡¯re getting a stem cell transplant at MD Anderson, there are many lodging options in or near the Texas Medical Center, including hotels, apartments, and trailer parks. Some offer special or reduced rates for people seeking medical treatment.?

But if you¡¯re visiting Houston for the first time, you might need some help sorting through it all. Our social workers can help. You can request a referral through or contact Social Work directly for assistance.

Be prepared: Have a ¡®go bag¡¯ ready

There¡¯s a good chance you might be on ¡°stand-by¡± status if you¡¯re waiting for stem cells to be provided by someone else. So, the next time you hear from your care team could well be the minute the transplant is actually ready ¡ª and you¡¯ll need to get to the hospital ASAP.

That¡¯s why it¡¯s helpful to have a ¡°go bag¡± packed with the essentials: you can get to the hospital quickly. Recovery from a stem cell transplant could take a month or longer. So, pack a few meaningful personal items like photos and other keepsakes, to make your room feel homier and less like a hospital.

Get your house in order before you leave

Now that you know you¡¯ll need to be in a hospital for at least 30 days, what has to happen to make that possible? Do you need to set up automatic bill payments through your bank? Ask a neighbor to get the mail and mow your lawn? Make arrangements with friends or siblings for long-term child care?

Not everyone has the flexibility to work remotely, but if you do, now¡¯s the time to look into it. If not, at least make sure your application for job protection has been granted through the Family and Medical Leave Act.

Unfortunately, life doesn¡¯t stop just because you¡¯re getting a stem cell transplant. But if you plan ahead as much as possible, you can make your own life ¡ª and those of others¡¯ ¡ª much less stressful.

John Lugo is a social work counselor who leads a bi-monthly support group for stem cell transplant recipients and their caregivers.?

or call 1-877-632-6789.

An immunosuppressant is anything that diminishes the body¡¯s natural ability to respond to threats, such as cancer or viruses, like the ones that cause the common cold.

Sometimes, due to autoimmune disorders such as lupus, multiple sclerosis, rheumatoid arthritis, scleroderma or Sj?gren¡¯s syndrome, the immune system is already suppressed. But in the context of cancer care, immunosuppressants are drugs that we sometimes give to patients.?

So, why might you need an immunosuppressant? How do immunosuppressants work? And, how are they used in the treatment of cancer and its side effects?

Read on for the answers to these questions and more.?

Why might somebody?need an immunosuppressant?

We use immunosuppressants?during?cancer treatment for several reasons.?

Before a?stem cell transplant

We give patients chemotherapy before a stem cell transplant to kill any remaining cancer cells and to dampen their immune systems. The goal is to create a ¡°clean slate.¡± That way, when donor cells arrive, they don¡¯t have a big fight on their hands. It¡¯s not impossible for donor cells to engraft properly if the host¡¯s own stem cells are still present, but it does make the process much more difficult.?

After a stem cell transplant

We use various drugs?after a stem cell transplant?to?prevent:?

• The patient¡¯s own immune system from rejecting the donor¡¯s cells
• The donor¡¯s cells from attacking the patient¡¯s tissues, a condition known as graft vs. host disease (GVHD)??

Other situations

Inflammation can be a positive sign that your immune system is working correctly. But when inflammation gets out of control, it can start causing problems. So, the ¡°fire¡± must stay within certain boundaries. You just want the warmth and the heat and the glow of a ¡°controlled burn,¡± not a raging wildfire. So, sometimes, we use steroids or other drugs to calm things down when a patient¡¯s immune system gets too ramped up.

Immunosuppressants are also used quite a bit in solid organ transplants, but we don¡¯t perform those here at UT MD Anderson.?

How do immunosuppressants?work?

That depends. The immune system is quite complex, so there are many different ways to calm it down. The two main branches involved are:?

1. Cell-mediated immunity,?which is driven?by?T cells
2. Humoral immunity,?which?is?driven?by?antibodies?and B cells? ?

Steroids eliminate both B cells and T cells, so they cover it all. Chemotherapy does the same thing.?Other drugs target just one type of cell.?So, it really depends on which branch of the immune system you¡¯re looking to calm down.?

What are some examples of immunosuppressants?

Name: Tacrolimus??
Class: Macrolide lactone??
±á´Ç·É?¾±³Ù¡¯²õ?³Ü²õ±ð»å:?A?calcurine?inhibitor?that?reduces?the activation of T cells and the production of a signaling protein called IL-2?
±á´Ç·É?¾±³Ù¡¯²õ?²¹»å³¾¾±²Ô¾±²õ³Ù±ð°ù±ð»å: comes in?pill and IV?form?

Name: Sirolimus??
Class: Macrolide antibiotic?
±á´Ç·É?¾±³Ù¡¯²õ?³Ü²õ±ð»å:?an?mTOR inhibitor?that?blocks?the activation of T cells?
±á´Ç·É?¾±³Ù¡¯²õ?²¹»å³¾¾±²Ô¾±²õ³Ù±ð°ù±ð»å: comes in?pill and liquid?form?

Name:?Mycophenolate??
Class: Antimetabolites?
±á´Ç·É?¾±³Ù¡¯²õ?³Ü²õ±ð»å:?mimics the nutrients T cells need and disrupts their growth process, which causes the cells to wear out and die much sooner than they normally would?
±á´Ç·É?¾±³Ù¡¯²õ?²¹»å³¾¾±²Ô¾±²õ³Ù±ð°ù±ð»å: comes in?pill and IV?form?

Name:?Abatacept??
Class:?Biologics?
±á´Ç·É?¾±³Ù¡¯²õ?³Ü²õ±ð»å:?blocks?the initial activation of T cells?
±á´Ç·É?¾±³Ù¡¯²õ?²¹»å³¾¾±²Ô¾±²õ³Ù±ð°ù±ð»å: comes in?IV form?only

Name: Cyclophosphamide?
Class: Alkylating agent?
±á´Ç·É?¾±³Ù¡¯²õ?³Ü²õ±ð»å:?given on days 3 and 4 after a stem cell transplant to reduce the reactive T cells that can drive GVHD??
±á´Ç·É?¾±³Ù¡¯²õ?²¹»å³¾¾±²Ô¾±²õ³Ù±ð°ù±ð»å: comes in IV form only?

But?these are?all different classes of drugs.?The?one thing they have in common is that?they?can?block or?calm down T cell activation, the process of ¡°waking up¡± the immune system to attack.??

Which immunosuppressant is used the most?

Tacrolimus is?probably the one we use?most?frequently with our stem cell transplant patients.?

How long do you have to remain on immunosuppressants?

That depends. If you¡¯ve had a kidney, liver or lung transplant, you¡¯ll likely be on them for the rest of your life. The reason is that those organs will continue to express their original donor¡¯s proteins, which your body would otherwise still recognize as ¡°not self¡± and attack, resulting in organ rejection. But stem cell transplant patients don¡¯t normally have to be on immunosuppressants for very long.

Stem cells can develop into many different types of cells. Once they¡¯ve engrafted properly and started copying themselves, all the new T cells and B cells created by your bone marrow will become your new immune system and become tolerant of your body tissues. That means any proteins expressed by your tissues will be familiar to your new immune cells.

That being said, most stem cell transplant recipients can expect to be on immunosuppressant therapy for about six months. If we see no evidence of GVHD during the first 100 days after a transplant, we can talk about stopping earlier. In some cases, that could be as soon as four months after a transplant.?

Can anything else cause immunosuppression?

Yes. Autoimmune disorders. But I tend to think of those as a supply and demand problem.?

There¡¯s only a limited supply of T cells and B cells in the body. With autoimmune disorders, the body is too busy attacking its own tissues to fight off infections. Its treatment is often geared toward eliminating T cells and B cells. So, that can reduce your immune response even more.

Viral infections can also suppress the immune system, especially if they infiltrate the bone marrow and affect the new graft in stem cell transplant recipients.

., is a stem cell transplant specialist.

?or?call 1-877-632-6789.

Stem cell transplants use healthy, immature cells to replace those that either aren¡¯t working properly in a person¡¯s bone marrow or have been destroyed by high-dose chemotherapy. They are often used to treat leukemia, lymphoma, myeloma and other blood disorders.??

There are two types of stem cell transplants:?

• Autologous stem cell transplants use a patient¡¯s own cells.??
• Allogeneic stem cell transplants use cells from a healthy donor.?

Why isn¡¯t everyone a candidate to use their own stem cells? Where do donor stem cells even come from? And, why is the risk of one particular side effect greater with allogeneic stem cell transplants than with autologous transplants??

Read on for the answers to these questions and more.?

Why isn¡¯t everyone a candidate to use their own stem cells for a transplant??

The type of stem cell transplant you¡¯re eligible for depends on:??

• your type of cancer?
• whether your bone marrow is healthy and cancer-free, and ?
• how your body responded to prior treatments, such as chemotherapy.??

Allogeneic transplants are the preferred type of transplant for blood cancers, such as leukemias, myelofibrosis, and sometimes lymphomas. If your bone marrow is also affected by the cancer and not healthy, we need the donor¡¯s immune cells to react against your cancer cells.??

Autologous transplants, on the other hand, are preferred when cancer is best treated with high-dose chemotherapy. This therapy often destroys the patient¡¯s bone marrow along with the cancer. We rebuild it by using your stem cells, which we collect beforehand.??

Where do donor stem cells come from?

Donor stem cells may come from one of three sources:?

• Blood relatives
• Unrelated adults (usually through the database) ?
• Umbilical cord blood??

But the goal is to try to find a fully matched donor, whether they¡¯re related to you or not.??

What makes someone a ¡®fully matched¡¯ donor?

A fully matched adult donor is someone whose human leukocyte antigens (HLA) are the same as yours. HLAs are two sets of proteins on the surface of our cells. We inherit them from our parents: one set from each. To be a ¡°perfect¡± match, an adult donor needs to have the exact same HLA proteins as you do. Their blood type doesn¡¯t matter.?

Umbilical cord blood, on the other hand, is still very ¡°na?ve,¡± in that it comes from a baby who was just born. So, its cells haven¡¯t been exposed to all of the same bacteria, viruses, fungi, allergens and other pathogens that adult immune systems have. The cord blood¡¯s HLA type does not need to fully match yours, though the more closely matched they are, the better.??

What are my chances of finding a fully matched adult donor?

That depends partially on the number of full siblings you have. There¡¯s a 25% likelihood of a full match between you and each one. But the odds of you finding a fully matched unrelated donor in the national donor registry depends on your ethnicity. Here is a breakdown of those figures:?

• White or European ancestry: 74%?
• Native American or Indigenous ancestry: 47%?
• Hispanic or Latino ancestry: <40%?
• Black or African American ancestry: 19%?

It is much harder for people of color to find a perfect match. That¡¯s why we urge members of those communities ¡ª especially younger people ¡ª to consider registering with the , formerly known as Be the Match.??

Are some people better candidates for allogeneic stem cell transplants than others?

Yes. But the criteria are complex. Important factors include whether your cancer is responding well to prior chemotherapy, how fit you are and the availability of a donor.??

The reason your body¡¯s response to chemotherapy is so important is that a donor¡¯s immune cells require several months to mount an attack against any residual cancer cells. So, if you still have too many at the time of transplant, they may overwhelm the donor¡¯s cells and not give them a fighting chance. This could cause the transplant to fail.?

What are the benefits of an allogeneic stem cell transplant?

An allogeneic stem cell transplant is what¡¯s known as a ¡°high-risk/high-reward¡± type of therapy.??

While the risk of developing a side effect known as graft vs. host disease (GVHD) is real and significant, an allogeneic stem cell transplant is also the only potential cure for diseases like acute lymphocytic leukemia, acute myeloid leukemia, myelodysplastic syndrome, and myelofibrosis and other myeloproliferative disorders.?

GVHD is extremely rare in autologous stem cell transplants because the donor stem cells are your own.?

What are the risks of an allogeneic stem cell transplant?

The biggest risks of allogeneic stem cell transplants are infections and GVHD.??

One of the most troublesome infections is caused by a pathogen called cytomegalovirus, or CMV. Just over half of all Americans have been exposed to it by age 40. But an anti-viral drug called letermovir has been available since 2017 to prevent its reactivation after a stem cell transplant.??

GVHD is when a donor¡¯s stem cells recognize the patient¡¯s normal body cells as ¡°other¡± and begin attacking it. We have a lot of good strategies available to prevent this, starting with finding the most well-matched donor. Another is the early use of a drug called cyclophosphamide, which targets the specific donor T cells that are more prone to reacting against the patient¡¯s normal cells and causing GVHD.??

How long does it take to fully recover from an allogeneic stem cell transplant?

That depends on several factors:? ?

• How long it takes a donor¡¯s cells to fully engraft, or establish themselves and start protecting you?
• How well you recover from the early side effects, and from GVHD, if it occurs?
• Whether other complications, such as infections, occur?
• Whether the cancer is still detectable early on, after a transplant??

But you should expect to stay in the hospital for at least 30 days after a transplant, and near the hospital for another two months. Data shows that acute GVHD or infections are most likely to happen within the first 90 days, so we want to be able to address them quickly if that happens.

Once you¡¯ve repeated all your childhood vaccinations, your immune system should be back to normal within about two years of a stem cell transplant.

What¡¯s the most important thing to know about allogeneic stem cell transplants?

One thing that surprises patients is how long it takes to recover. Some expect to feel normal again after just 30 days. But it can take six months or more for your energy levels, strength and even taste buds to bounce back.

, is a stem cell transplant specialist.

or by call 1-877-632-6789.