What to expect?
During the harvest, I think it's
your calcium levels, can get out of whack. If they do you
will start to feel tingling in your lips or possibly
somewhere else. You tell your nurse and she will give you some
Tums to chew on which quickly set things right.
You will have a nurse with you constantly while harvesting
cells. You're pretty much confined to the bed you're in
for the duration because you are hooked up to the machine, so
bring with you something to read, a computer or someone to chat
with. Post harvest there really is nothing. Your cells will be
either frozen there or sent somewhere to be frozen.
~ source: Lay comment from Pooh-Bah
How long can
stem cells be stored?
"After
processing, PBSC are cryopreserved for later infusion.
Controlled-rate freezing with temperature curve monitoring is
required. Until required for infusion, products are stored in
the vapor phase of liquid nitrogen. Usually the storage period
is weeks to months; however, stem cell products have provided
adequate engraftment when infused 10 years after
cryopreservation.
After
thawing, PBSC again are checked for viability. Because granulocytes
do not survive cryopreservation, loss of this cell
fraction from the collection is expected. To allow survival
during freezing and thawing, cells are placed in a medium
containing 7.5-10% dimethyl sulfoxide.
Because cells lose
viability over a short period in this medium, infusing the cells
immediately after thawing is important."
Source: emedicine
What is
portability?
Although preferred to be stored at the center of eventual
transplant they are fully portable. It was not a consideration
as they transport stored cells from center to center all the
time as a standard practice.
~ Source: RB (Lay comment)
Insurance
coverage?
For stem cell
transplant, the harvesting portion will be covered as part of
the package. Otherwise your doctor will have to submit the
rationale to the provider: that it is reasonable and/or there's
a pressing need. Just banking for a relapse by itself probably
will not be compelling enough with most insurance companies.
Source: ~ KS & RB (lay comment)
When
to harvest stem cells?
=We propose, but only as a starting point for discussions
with your doctors:
A) You feel that you will require and be eligible for stem cell rescue
therapy in future (favoring younger age, good performance, higher-risk lymphoma)
Best timing?
B) A is true, and you've completed therapy and have minimal disease?
C) A is true, and just prior to therapy that is considered harsh on stem
cells (Fludarabine-based chemo / RIT)?
=A
lymphoma expert commented:
" [The proposal] sounds reasonable, however we don't typically harvest stem cells (without using them) in MCL or DLBCL in advance of immediately using."
=Another expert wrote:
"To me, in fnhl stem cell harvest may take place after first CR (if any bad prognosis indicator is found), or after second CR. As for when to
use them, to me, currently, second CR should almost always be consolidated with an autologous stem cell transplant (but this is only
my opinion).
=A patient wrote:
I completed CVP but did not achieve a persisting remission, so I was prescribed RCHOP. Before starting it, John Leonard suggested that on completion of that therapy, I should stockpile my stem cells in case of future transformation. His recommendation was that I take that opportunity before damaging my marrow/stem cells irrevocably with subsequent treatments (eg Fludara or RIT). Since my indolent follicular disease was not seen as appropriate for treatment with autologous stem cell transplantation, the stockpiling was solely to deal with the possibility of transformation to diffuse (aggressive) lymphoma for which autologous transplant might have some utility. The RCHOP cleared my marrow (at least in the area they biopsied) and was able to store stem cells in case I need them in future.
=Our experience (follicular): Joanne had her stem cells harvested prior to
Bexxar (RIT). She had many prior treatments, including CHOP, and her marrow was clean (PCR testing) following low dose PEP-C. We felt the conditioning protocol for harvesting (high dose
Cytoxan) would also debulk further, prior to RIT, giving her a better chance to get a durable CR from bexxar.
What
about purging to remove lymphoma cells from harvested stem cells?
=We expect the answer of benefit from purging is dependent
on clinical factors, including the lymphoma subtype and methods
used to purge.
"Purging of neoplastic cells for autologous stem cell
transplantation is usually done in vivo by administering
chemotherapy and/or other agents before harvesting. It is also
possible to decrease malignant cells counts directly in the cell
harvest." http://www.ncbi.nlm.nih.gov/pubmed/15186735
"In vitro purging is labour intensive, costly and, as yet,
the effect on relapse is unclear." http://www.ncbi.nlm.nih.gov/pubmed/11840153
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