Advances in the treatment of cancer 和 improvements in supportive care over the past 10 years have improved the results 和 tolerability of stem cell transplants. However, a stem cell transplant remains an involved 和 potentially dangerous procedure. 自体移植, the patient receives his or her own bone marrow or stem cells that were collected 和 frozen before admission for high-dose chemotherapy or radiation.
自体移植
准备
移植前评估
A stem cell transplant specialist will begin the evaluation by reviewing your medical record 和 history, 给你做身体检查,并和你讨论检查过程. If your doctor decides that you are a c和idate for an autologous stem cell transplant, 他或她会推荐一个治疗方案.
提前进气测试
在被送进十大赌博平台排行榜之前, you will have several days of laboratory 和 other diagnostic tests to determine if you have normal function of the heart, 肺, 肾脏和肝脏,并且你没有未确诊的感染. Most of these tests will be done as an outpatient before you are admitted to the hospital, 但其他可能需要在你入院治疗后完成. 这些测试可能包括:
- 血液测试
- 尿液收集
- 骨髓抽吸 和 活组织检查
- 胸部x光片
- 肺功能检查(PFTs)
- 计算机断层扫描(CT)
- 心电图(EKG或ECG)
- 心脏扫描或超声心动图
- 鼻窦x射线
- 腰椎穿刺
干细胞收集
Stem cells are found predominantly in the bone marrow but can be stimulated to travel out into the blood. 当干细胞通过多次骨髓移植从髋骨中收集时, 哪些手术通常在手术室进行, 移植过程被称为骨髓移植. 现在很少有人这样做了. When the stem cells are collected from the blood after stimulating the stem cells with a hormone called G-CSF, 或者一种叫做普利沙的新型药物, 这种移植称为外周血干细胞移植. Currently, most transplant procedures involve collecting stem cells from the peripheral blood.
当骨髓或血液干细胞被注入病人体内, they are administered through an intravenous catheter (IV) or central venous catheter, 就像输血一样. 干细胞不能直接注入骨骼, 而是从血液流向骨骼.
更多信息,请访问 移植前评估 和 在十大赌博平台排行榜 各节 自体移植指南.
过程
大剂量化疗
Chemotherapy begins soon after you are admitted to the hospital, after stem cell collection. 你的十大赌博平台排行榜会告诉你所有的药物和它们的副作用. Your nurse practitioner, inpatient nurse 和 pharmacist also will be available to answer questions. 此外,您可能会在同意书中收到有关这些药物的书面信息.
采取了一些预防措施以尽量减少这些药物的副作用. 例如, 当接受某些类型的化疗时, patients must shower thoroughly twice a day to remove the drug that is excreted through the skin — this is done to help prevent or minimize chemotherapy burns. 住院护士会详细说明你可能需要采取的特别预防措施. Your doctor may also discuss medication (palifermin) to prevent some transplant-related complications prior to admission.
全身照射
一些患者在化疗的同时接受全身照射(TBI). This radiation therapy is intended to destroy remaining cancer cells 和 further suppress the immune system.
TBI treatments are given in the radiotherapy department, usually over a period of three to four days. 治疗本身是无痛的, 但治疗后可能会有不舒服的副作用, 比如口腔和咽喉溃疡, 恶心想吐, 肠胃不适, 皮肤发红. 每次治疗前通常要服用抗恶心药物以减少恶心. 你可能会接受额外的药物(palifermin)来防止口腔溃疡.
移植程序
The transplant will occur one to three days after your last chemotherapy dose or anytime after your last radiation dose. 移植当天称为第0天. The days before the transplant are counted as minus days 和 the days after the transplant are plus days.
The procedure is similar to a simple blood transfusion 和 will be done in your hospital room. 如果您愿意,您可以请一位家庭成员与您同住. The actual procedure will take about 45 minutes, depending on the volume of stem cells. 如果你正在接受骨髓,输注可能需要几个小时. 血液干细胞将通过你的中心静脉导管注入.
你的护士会检查你的血压, 温度, 呼吸和脉搏, 并注意是否有副作用. 通常没有副作用, 但偶尔患者可能会在口腔中感受到一种奇怪的味道, 发冷, 脸红, 恶心和呕吐, 头疼, 血压和呼吸的变化.
等待移植
新骨髓在移植后不会立即恢复. 移植骨髓中的干细胞会进入骨骼, reseed the marrow space 和 go through a growth process before the mature cells are released from the bone marrow into the blood stream. It will take eight to 14 days from the day of transplantation for your marrow to start producing white blood cells, 红细胞和血小板.
Engraftment is the term used to describe when your new marrow begins to function 和 produce cells. While awaiting engraftment, no mature cells leave the marrow 和 enter the blood stream. Your blood counts will show very low values 和 you will require careful monitoring by the health care team. The goal is to support you with red blood cell 和 platelet transfusion until you are producing cells again.
复苏
延迟性副作用
The body feels the effects of the chemotherapy or radiation about a week after transplantation. When the blood counts are low, you feel like you have the flu 和 may not want to do much. 这将持续大约两周,并会随着你的血液计数的提高而减少. 您可能还会注意到许多其他症状,包括:
- 食欲不振
- 恶心和呕吐
- 视力变化
- 口腔和喉咙疼痛
- 腹泻
- 睡眠困难和疲劳
- 感染
- 脱发
- 皮肤反应
- 移植物抗宿主病
有关这些副作用的详细信息,请参阅 治疗 部分 自体移植指南.
准备离开十大赌博平台排行榜
When your neutrophil count is over 1,000, your team will start talking to you about discharge. You will need to be sure that arrangements have been made for someone to stay with you after you are discharged, 协助您的日常需求,并为您的诊所访问提供交通服务. 您或您的家人将学习如何护理您的导尿管.
要想出院,你需要:
- 走
- 每天至少摄入1000卡路里
- 每天至少喝一夸脱液体
- 没有活跃的医疗问题
- 不发烧
- 不用静脉注射药物,不用吃药
- 表明你可以照顾你的静脉导管,如果出院后需要它
病例管理员将协助安排家庭护理. The nurse practitioner will go over your discharge 和 outpatient instructions 和 the pharmacist will review your medications with you.
常规门诊就诊
Your BMT doctor 和 nurse practitioner will follow you closely after your transplantation. You will have blood work done 和, if necessary, will receive intravenous medications or fluids.
保持健康
Your risk of infection will remain higher than normal for at least three months after autologous BMT, 即使你的身体再次产生白细胞. The highest risk is within the first month of leaving the hospital; during this period you should spend most of your time at home 和 away from people, 哪个叫软禁. 你将被指导如何帮助预防感染, 包括洗手, 避开人群,不吸烟.
加州大学旧金山分校健康医学专家已经审查了这些信息. It is for educational purposes only 和 is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.