Hello again Wilbur,
I can tell you are agonizing about selecting the very best doctor
and hospital for your brother. After my research on Dana-Farber and
Dr, Stone, along with your brother?s feelings, I am inclined to
believe it is the best place for your brother. To be honest, before
you mentioned the mini-transplant, I felt any of the top hospitals in
the US would be more than adequate. Now that your brother?s therapy
includes a mini-BMT, Dana-Farber and Dr. Stone sound like the absolute
best selections!
Since I?m not a hematologist, (I?m a medical technologist with a great
deal of work in special hematology), I?m not sure of the line of
cells/blasts your brother has, so I can?t address his blast count.
I?m not sure where the hematologist would like your brother?s blast
number to be. Healthy people have 0%-2% blasts in their bone marrow,
along with other immature cells, metamyelocytes being one of the most
prominent. There are several GCSF medications to increase white cell
production and well as drugs that can increase red cell production,
such as epoetin alfa, and I don?t know if your brother is receiving
any of these.
A mini-BMT is a ?non-ablative? transplant, that allows the patient to
receive smaller amounts and less toxic forms of chemotherapy. It is
based on the graft vs. disease effect; the donor?s immune cells attack
and ideally eradicate diseased cells in the patient?s bone marrow.
The mini-BMT was first developed in 1997 at the Fred Hutchinson Cancer
Research Center, by Dr. Ranier Storb.
?Survival rates among patients who receive a mini-transplant range
from 30 percent to 70 percent, depending on the underlying disease,
disease stage and whether the patient has other illnesses at the time
of treatment, according to Storb.?
http://www.fhcrc.org/about/ne/news/2005/08/04/minitransplants.html
?About four years ago, research came up with the mini-transplant, a
process which is still looked upon as under development but has been
carried out in several countries around the world. It still requires
donor marrow but the advantage of this technique lies in the much
lower dose of chemotherapy &/or radiation therapy required in the
pre-transplant stage; the minimum of dosage, hence the name.
So straight away this is much less stressful on the body than the
normal BMT. A mini-transplant's lowered treatment regime does not
necessarily immediately destroy all the patient's rogue cells but
cells in the transplanted marrow apparently recognise the existing
aberrant cells and gradually set about destroying them.
Both lots of cells present at once is called mixed chimerism - luckily
you don't have to remember this name. Prevention of rejection can be
achieved by giving small doses of the drug fludarabin before
transfusion, or newer drugs such as orBec (Beclomethasone
Dipropionate). Such transplants allow later infusion of white blood
cells (T-lymphocytes) from the bone marrow of the original donor where
this will help in topping-up the process.
The result is that instead of several weeks in hospital for the normal
BMT, the procedure can be carried out within a day at an out-patients'
clinic. The nausea/diarrhoea met with in conventional treatment are
now minimal and hair-loss avoided. All this must surely be an enormous
advantage. Additionally, since it is so much less severe, it can
seemingly be carried out on patients even in their 60s and 70s - well
beyond the normal BMT cut-off age.?
http://www.ib014a7519.f2s.com/rlb/MDSMain.htm
You don?t say whether plans include a stem cell mini-BMT
(nonmyeloablative stem cell transplantation or NST) for your brother
or not. Here is an abstract, co-authored by Dr. Richard Stone, From
the Departments of Medical Oncology and Biostatistical Science,
Dana-Farber Cancer Institute, Boston, MA; Department of Medicine,
Brigham and Women's Hospital, Harvard Medical School, Boston, MA.:
?Despite the adverse characteristics, overall survival was improved in
the NST group at 1 year (51% versus 39%) and 2 years (39% versus 29%;
P = .056).?
http://www.bloodjournal.org/cgi/content/abstract/105/4/1810
?Mini-transplants can be used alone, but are generally not very
effective due to limited graft-versus-myeloma effects. They appear to
be more effective when used in combination with an autologous stem
cell transplant. In this type of tandem transplant, patients first
undergo an autologous stem cell transplant, which may provide
substantial anti-tumor effects. This is followed by a mini-transplant
from a matched donor two to four months later. This strategy is
designed to provide a sequential anti-tumor effect from the two
transplants and a potential graft-versus-myeloma effect from the
allogeneic mini-transplant.?
?Investigators at the Fred Hutchinson Cancer Research Center also
evaluated a mini-transplant strategy in patients with previously
treated stage II or III myeloma. (Maloney et al. Blood.
2003;102(9):3447-3457.) In this study, 54 patients aged 29 to 71 years
(median, 52 years) with received an autologous transplant followed by
a mini-transplant that included total body irradiation (TBI) as a
conditioning regimen and immunosuppression with mycophenolate mofetil
and cyclosporine. The mini-transplant improved on the responses
achieved with the autologous transplant. With a median follow-up of
552 days after receiving the allograft, the overall survival was 78%.
Thirty-eight percent of patients experienced early (acute)
graft-versus-host disease (GVHD), most of which was moderate in
severity, and 46% experienced late (chronic) GVHD that required
treatment.?
http://www.multiplemyeloma.org/treatments/3.03.05.html
?How does a 'Mini' BMT differ from a conventional BMT?
In 1998 GOSH became one of the first hospitals worldwide to
successfully carry out Mini BMTs in children, representing a new
breakthrough procedure suitable for some children who were not
eligible for a conventional transplant procedure. Rather than killing
off a child's own bone marrow cells, a Mini BMT involves suppressing
the child's immune system so donated bone marrow cells are not
rejected, but grow alongside the recipient's bone marrow. The
treatment is more easily tolerated by very sick children because the
doses of chemotherapy needed are lower than in conventional or full
BMT.?
http://www.ich.ucl.ac.uk/pressoffice/feature/bmt/bmt_faq.html
?The concept of utilizing enhanced immunosuppression rather than
myeloablative cytotoxic conditioning has allowed the engraftment of
allogeneic stem cells from related and unrelated donors with lower
early transplant-related mortality (TRM) and morbidity. This approach
shifts tumor eradication to the graft-vs-host immune response directed
against minor histocompatibility antigens expressed on tumor cells.?
According to this site, the mini-BMT still carries risks: ?This is not
without risk, as the long-term effects of graft-versus-host disease
(GVHD), it?s treatment, or resulting complications and
immunodeficiency may be life threatening. However, this approach does
allow the application of a potentially curative procedure to elderly
or medically infirm patients who would not tolerate high-dose
conditioning regimens.?
http://www.asheducationbook.org/cgi/content/full/2002/1/392
Mini-BMTs can also be utilized after conventional BMTs fail:
http://www.asheducationbook.org/cgi/content/full/2002/1/392#T1
?First developed at Fred Hutchinson Cancer Research Center in 1997,
the mini-transplant is offering new hope for older patients with
leukemia, lymphoma and other serious blood diseases ? a population
that is often medically unfit to withstand the rigors of a
conventional blood (hematopoietic) stem-cell transplant. And, the
therapy shows promise for treating some solid tumor cancers.?
?The key to a mini-transplant's curative powers are donor immune
cells, known as T lymphocytes or T cells, which recognize the
patient's cancer cells as foreign and target them for destruction ? a
property known as the graft-vs.-tumor effect.
The mini-transplant is not without risks. Some cells in the mixture
given to patients also recognize healthy cells, thus triggering an
undesired immune response called graft-vs.-host disease, in which
donor cells recognize the patient's healthy cells as foreign,
sometimes resulting in destruction of healthy tissue. This can occur
in transplants involving non-twin siblings or unrelated individuals.?
?Hundreds of mini-transplants have been done at the Hutchinson Center
and at more than a dozen other centers around the country that are
collaborating with Hutchinson Center researchers to further refine the
procedure. For example, the first mini-transplants were done only with
donor cells from a patient's sibling; now unrelated donor cells are
being transplanted as researchers find better ways to minimize
graft-vs.-host disease.?
?Hundreds of mini-transplants have been done at the Hutchinson Center
and at more than a dozen other centers around the country that are
collaborating with Hutchinson Center researchers to further refine the
procedure. For example, the first mini-transplants were done only with
donor cells from a patient's sibling; now unrelated donor cells are
being transplanted as researchers find better ways to minimize
graft-vs.-host disease.?
Because of copyright restrictions, I am unable to post the entire
article here. Please read the entire article for further information.
http://www.fhcrc.org/about/ne/news/2005/08/04/minitransplants.html
?MDS is not in itself a killer but the ailments in induces can be. It
is convenient to relate these to the deficient blood cell types.
Lack of red cells, as mentioned earlier, makes you very short of
breath and is generally debilitating. As the saying has it," my
get-up-&-go has got-up-&-gone". This is common to all forms of
anaemia. It also helps to induce or accentuate lung trouble, which can
lead to acute bronchitis or pneumonia, both potential killers. There
is also strain put on the heart, since it beats more rapidly to try to
make up for the oxygen deficiency consequent upon the low red cell
numbers. Eventually it could give up the fight and fail.
Lack of white cells means that your resistance to bacterial and viral
infection is reduced. These, after all, are the body's main line of
defence. So you will be pretty wide open to attack by a range of
nasties, some of which, like respiratory ailments deriving from
influenza, or infection getting into wounds and then spreading, can
turn out to be fatal if not checked. In view of the very short life of
white cells, this is difficult to guard against.
Low platelet count can result in spontaneous bleeding, so bleeding
from the gums or nose is not uncommon. These are not much of a worry
but internal bleeding from any of several organs certainly is.
For some, the final illness will be acute myeloid leukaemia (AML). If
the MDS has progressed through the various stages of the disease
mentioned in the previous paragraph, then this will be the ultimate.
Those blast cells no longer differentiate into the three main blood
elements and so, unaltered, they start to proliferate in the blood.
This makes the blood light-coloured, hence the Leuk- bit of the word
(Greek leukos = white). MDS used to be called pre-leukaemia or smoking
leukaemia before the advent of the FAB classification and that is
about right.?
This page had additional very worthwhile information on what to watch
for, such as fungal infections, cuts, bruising, and exercising the
lungs.
http://www.ib014a7519.f2s.com/rlb/MDSMain.htm
?Researchers report that low-dose radiation therapy combined with
immunosuppressive drugs allows donor stem-cell transplants in patients
who cannot have conventional stem-cell transplants using donor stem
cells or their own stem cells. Results from the study will be
published in the June 1 issue of the journal Blood.
The toxic effects of conventional stem-cell transplants are a major
problem for older patients or younger patents with medical problems.
In the Fred Hutchinson Cancer Research Center-led study, researchers
found that non-myeloablative stem-cell transplants, also known as
mini-transplants, are a treatment option for these patients. The
mini-transplant involved low doses of radiation, coupled with
post-transplant immune suppression, to establish a stable state of
tolerance between the donor cells and the patient's own tissues, a
phenomenon called "mixed hematopoietic chimerism."?
?The study involved 45 patients treated between 1997 and 1999 who were
ineligible for a conventional bone marrow or stem-cell transplant. The
patients were of a median age of 56 years and had been diagnosed with
acute and chronic leukemia, multiple myeloma, non-Hodgkin's lymphoma,
and other diseases often treated with bone marrow transplantation.
Eight patients with chronic leukemia entered a complete molecular
remission, which is a state of no detectable cancer cells, and this
suggests strongly that donor immune cells might eradicate these
diseases. The patients were followed through their treatment and
recovery period, an average of 417 days, and survival among the
patients was approximately 66 percent.?
http://www.fhcrc.org/about/ne/news/2001/06/01/minitran.html
This chart indicates mortality results for mini-BMTs in several studies:
http://www.asheducationbook.org/cgi/content/full/2002/1/392/T1
This chart shows survivability charts for mini-BMTs using allogenic
(From a stranger), a sibling, and untreated.
http://www.marrow.org/PHYSICIAN/advances_conditioning_regimens.html
The BMT Network site has a chart to find centers that perform mini-BMTs.
Select ?Nonmyeloablative? as the type of transplant, and ?Other:
myelodysplasia? as the disease.
http://www.bmtinfonet.org/centers/
Then, by clicking on the center?s name, from the list, you will get
results for the number of BMTs performed. Here are Rocky Mountain?s
statistics:
http://www.bmtinfonet.org/centers/index.cfm?FuseAction=Center&CenterID=224
Dana-Farber(Brigham & Women's Hospital) Dana-Farber performed 68
Nonmyeloablative transfusions in 2002, and 82 in 2004.
http://www.bmtinfonet.org/centers/index.cfm?FuseAction=Center&CenterID=5
Entering Colorado into the drop down menu shows both Rocky Mountain
Blood and Marrow Transplant Program and University of Colorado
perform mini-BMTs. Rocky Mountain as performed 14 Nonmyeloablative
transplants in 2002, 12 in 2003, and 27 in 2004.
http://www.bmtinfonet.org/centers/index.cfm?FuseAction=Search
http://www.bmtinfonet.org/centers/index.cfm?FuseAction=Reports
Fred Hutchinson, in Seattle, has performed 77 Nonmyeloablative in
2002, 90 in 2003, and 72 in 2004.
http://www.bmtinfonet.org/centers/index.cfm?FuseAction=Center&CenterID=127
From the Fred Hutchinson Cancer Research Center:
?Hematopoietic cell transplantation (HCT) is currently the only
treatment with curative potential for myelodysplastic syndromes (MDS)
and myeloproliferative disorders (MPD). Among patients with less
advanced MDS, 3-year survival rates of 65% to 75% are achieved with
HLA-identical related and unrelated donors. The probability of relapse
is less than 5%. Among patients with advanced MDS (?5% marrow blasts),
about 35% to 45% who receive transplants from related donors and 25%
to 30% who receive transplants from unrelated donors are in re mission
beyond 3 years. The incidence of posttransplantation relapse is 10% to
35%. Criteria of the International Prognostic Scoring System
(originally developed for nontransplant patients) also predict relapse
and survival after HCT. Transplantation is successful in 50% to 80% of
patients with MPD if performed before leukemic transformation.
Depending on the individual risk profile, a considerable number of
patients with MDS or MPD are cured by allogeneic HCT.
However, HCT should be performed before disease progression. Outcome
of patients with treatment-related MDS or with relapse after
transplantation remains poor. At present, no definite conclusions can
be made with regard to reduced-intensity transplantation regimens.?
?To facilitate the decision process about whether to proceed to HCT,
an algorithm for MDS treatment was developed by the National
Comprehensive Cancer Network Myelodysplasia Panel.?
?For patients younger than 60 to 65 years with good performance status
in intermediate-2 or high-risk IPSS groups, HCT appears to be the
treatment of choice. In patients older than 60 to 65 years with
adequate performance status, low-intensity therapy may be preferable
unless they qualify for a nonmyeloablative transplantation?
http://www.mayoclinicproceedings.com/inside.asp?AID=399&UID=
?Non-Myeloablative Regimens
Non-myeloablative regimens use significantly lower doses of
pre-transplant chemotherapy drugs and/or radiation than the
traditional high-dose, myeloablative regimens that have been in use
for more than 35 years. Non-myeloablative regimens do not attempt to
completely eliminate malignant cells prior to transplant, but instead
rely upon a graft-versus-malignancy effect mediated by donor-origin T
cells. [1]
Non-myeloablative transplants have expanded the number of patients
eligible for hematopoietic cell transplantation. Due to its lowered
toxicity, non-myeloablative transplants can be appropriate for:
· Patients older than 55 years, which is a common upper limit for
standard myeloablative transplantation
· Patients with one or more co-morbidities that would ordinarily
exclude them from undergoing myeloablative transplantation
Although long-term follow-up data are not yet available, lower TRM and
reduced rates of acute and chronic GVHD have been achieved in older
patients and in patients with co-morbidities receiving
non-myeloablative transplants, with rates comparable to those achieved
by younger transplant patients. [2]
Clinical studies of non-myeloablative transplantation have shown that
the graft-versus-malignancy effect is particularly pronounced in:
· Chronic myelogenous leukemia
· Chronic lymphocytic leukemia
· Low-grade, non-aggressive lymphomas [1]
Autologous transplant followed by non-myeloablative allogeneic
transplantation is also being investigated by several groups. This
treatment strategy attempts to combine the tumor cytoreduction of a
high-dose autologous transplant with the lowered TRM of a
non-myeloablative conditioning regimen with an allogeneic transplant.
This technique has been particularly successful in treating patients
with multiple myeloma. [3]?
http://www.marrow.org/PHYSICIAN/advances_conditioning_regimens.html
?Having made the momentous decision to undergo unrelated-donor HSCT,
patients are often eager to proceed immediately--but that is not
possible. Simply locating the donors may take some time (e.g., they
may be on vacation), and further HLA typing may be needed. A
successful NMDP search takes about four months. In this case, the
donors were matched with the recipient at the HLA-A and HLA-B loci
using serologic typing methods, and at the HLA-DR-beta1, HLA-DP and
HLA-DQ regions using newer molecular typing methods. Use of molecular
typing techniques has improved the outcome of unrelated-donor
transplantation.
There has been some controversy whether the outcome of HSCT is
negatively affected in patients who first receive interferon therapy.
Some investigators maintain that any use of interferon greatly worsens
the outcome of HSCT, whereas others have observed no effect on HSCT
outcome. A recent European study suggests that both arguments have
some validity: Interferon did have an adverse effect on the outcome of
HSCT, but only if used within three months of transplantation.
Candidates for unrelated-donor HSCT should be counseled about the
risks and benefits of the procedure. Graft failure occurs in about 10%
of cases, rendering the patient at risk of infection and death. The
donor cannot always be reached to provide a second donation, and even
if a second donation is obtained, the stem cells may not engraft.
Another risk is graft-versus-host disease (GVHD). Donor lymphocytes
reacting against host tissue may cause rash, abdominal cramping and
diarrhea, jaundice and liver failure, and even immune dysfunction
(leading to opportunistic infections). GVHD can range from a minor
disorder to a severe, chronic syndrome that may eventually be fatal.
Immunosuppression is used both to prevent and treat GVHD. Unlike
kidney or heart transplant recipients who require lifelong
immunosuppression, most HSCT recipients eventually tolerate the graft.
Before transplantation, recipients are given high doses of
immunosuppressive chemotherapy and, in some centers, radiation,
leaving patients susceptible to potentially fatal bacterial, fungal,
or viral infections. The immune system may not recover fully for a
year after transplantation, so even recipients who are doing extremely
well receive antibiotic prophylaxis during that time. Because
chemotherapy and radiation suppress the hematopoietic system, patients
need red blood cell (RBC) or platelet transfusions until engraftment
and repopulation of the hematopoietic compartment has occurred. Blood
products are irradiated to prevent inadvertent engraftment of
transfused hematopoietic cells.?
http://www.hosppract.com/issues/2000/08/dmmmcgl.htm
?In either case, blood-forming stem cells collected from the donor or
the patient are carefully frozen and stored. The patient then receives
high-dose chemotherapy and sometimes whole body radiation treatment as
well. This destroys remaining cancer cells, but it also kills all or
most normal cells in the bone marrow. After therapy, the frozen stem
cells are thawed and returned to the body like a blood transfusion.
What stem cell transplant involves: For an autologous stem cell
transplant, the stem cells are collected on several occasions in the
weeks before treatment.
If radiation is to be used, a radiation oncologist will see the
patient before the stem cell transplant is done and will take
measurements of the patient so that radiation shields can be built to
protect the lungs, heart, and kidneys from damage during high-dose,
whole body radiation therapy.
The patient getting the stem cell transplant may be admitted to the
bone marrow transplant unit or receive treatment as an outpatient
depending on a number of factors.
If done as an inpatient, the day before chemotherapy begins the
patient will receive instructions from the nurses about wearing
sterile gowns and preparing food.
If done as an outpatient, patients and families must be able to spot
complications requiring their doctor's attention. Unless they live
close to the transplant center, they will be asked to stay in a nearby
hotel.
After the proper education, the patient starts high-dose chemotherapy
and may be given high-dose whole body radiation. Once treatment is
complete, the stem cells (autologous or allogeneic) are given through
a vein or venous access line, just like a transfusion. The stem cells
migrate to the bone marrow. Then the waiting period begins.
Patients who receive someone else?s stem cells are given antirejection
drugs (tacrolimus or cyclosporine, sometimes combined with prednisone
or methotrexate) that suppress their immune system. For the next 3 to
4 weeks the patient is given as much supportive therapy as needed.
This can include IV nutrition; antibiotics to treat bacteria, viral,
and fungal infections; red blood cell transfusions; platelet
transfusions; or other medicines as needed.
Usually around 14 to 21 days after the stem cells have been infused,
they begin making new white blood cells. This is followed by the
production of platelets and red blood cells. Patients remain in
protective isolation until their white blood cell count rises above
500. They can usually leave the hospital when their white blood cell
count nears 1,000.?
http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Stem_Cell_Transplantation_32.asp?sitearea=
=================
Dr. Richard Stone
=================
Dr. Stone?s profile:
?Dr. Stone received his MD in 1981 from Harvard Medical School, his
internal medicine residency training at Brigham and Women's Hospital,
and his hematology-oncology fellowship at DFCI. He has performed
numerous laboratory and clinical studies on acute leukemia and related
disorders, and frequently participates in grand rounds worldwide. He
is currently the clinical director of the Adult Acute Leukemia Program
at DFCI and is vice chair of the Leukemia Core Committee for the
national cooperative trials group Cancer and Leukemia Group B.?
Richard Stone, MD
Dana-Farber Cancer Institute
44 Binney Street
Dana 840
Boston, MA 02115
USA
office phone: (617) 632-2214
fax: (617) 632-2933
e-mail: rstone@partners.org
preferred contact method: e-mail
http://www.dana-farber.org/pat/dana-farber/detail.asp?personID=219&group=(Clinician+and+Researcher)
Dr. Stone?s publications and awards:
http://www.dana-farber.org/pat/dana-farber/detail.asp?PersonID=219&RD=True
Healthgrades can supply you with a complete report on Dr. Stone, for a fee.
http://www.healthgrades.com/consumer/
Here is a sample report:
http://www.healthgrades.com/consumer/index.cfm?fuseaction=mod&modtype=content&modact=SHOP_Report_ForceExample&type=PhysQual&subact=results&last_name=stone&state=MA&specialty=67&city=Boston
And as far as I could get without paying $7.95, for Dr. Stone?s report:
http://www.healthgrades.com/consumer/index.cfm?fuseaction=Mod&modtype=PRC&modact=prc_profile&hgid=HGPY6A7B3AD0808996941
Dr. Stone has been involved with numerous clinical trials at Dana-Farber
http://www.brighamandwomens.org/bwhcancer/clinical/bonemarrowtransplant/clinicaltrials.pdf
===========
Dana-Farber
===========
Dana-Farber has been involved in numerous clinical trials and research?
http://www.dana-farber.org/can/clinical/default.asp?audience_id=&doc=CDR349416.xml&is_active=True
Dana-Farber completed its 500th mini-MBT in Nov.2002
?A 57-year-old Michigan resident, Dockerty received his marrow from an
anonymous donor through a procedure known as a non-myeloablative
transplant. Much lower doses of drugs are used in this process than in
traditional transplants, sparing the patient from the complications of
high-dose therapy and germ-free isolation.
"As transplants go, this was about as smooth as we could get it to
go," says Dockerty's physician, John Gribben, MBChB, MD, of Medical
Oncology. "In Don's case, it was easy to find a match, so we were able
to go forward quickly."
?The milestone of 500 unrelated-donor transplants is a significant
one, and speaks volumes for the success of Dana-Farber's program.
"We've been doing unrelated transplants here for more than a decade,"
says Joseph Antin, MD, chief of stem cell transplantation in Medical
Oncology at DFCI and medical director, Bone Marrow Transplant at
Brigham and Women's Hospital. "It's a dangerous procedure, but through
local and national research that we've been major participants in,
excellent headway has been made in enhancing the success of this
procedure and curing people."
http://www.dana-farber.org/res/research/transplant_milestone.asp
?The transplantation units at both centers are specially designed
facilities, which include standard and enhanced hepa-filtration,
positive air flow pressure and laminar air flow units. Patients
receive world-class care by a team of specialists, including a medical
oncologist, radiation oncologist, hematopathologist, infectious
disease specialist, oral surgeon, nutritionist and social worker. The
programs at both sites of care have the advantage of being part of
highly-regarded general acute hospitals that are capable of addressing
any complication or specific consultative need that might arise with
stem cell patients. Patients and family members have access to support
groups and educational programs; complementary therapies; and
low-cost, short- and long-term housing.?
http://www.nccn.org/members/profiles/dfci.asp
?Bone Marrow/Stem Cell Transplant: Dana-Farber and Children?s Hospital
Boston have one of the first such transplant programs in New England
and conduct one of the largest unrelated and alternate donor programs
in the nation. Dana-Farber is blazing the trail in areas such as the
treatment of high-risk solid tumors, infant transplantation and other
specialized protocols. Types of malignancies treated include: acute
lymphocytic leukemia, acute myelogenous leukemia, chronic myeloid
leukemia, lymphomas, and solid tumors. A special inpatient unit at
Children?s Hospital has laminar airflow or hepa-filtered rooms to help
prevent infection. Care for stem cell/bone marrow transplantation is
provided by a multidisciplinary team.?
http://www.nccn.org/members/profiles/dfci.asp#SpecialExpertise
?Dana-Farber attains nation's highest honor for nursing excellence;
first cancer center in New England to earn Magnet recognition?
http://www.dfci.harvard.edu/abo/news/press/dana-farber-nursing-excellence-magnet-recognition.asp
?People come from all over the world to receive stem-cell or
bone-marrow transplants at Brigham and Women's Hospital (BWH) in
Boston. BWH is affiliated with the Dana- Farber Cancer Institute
(DFCI), so patients receive inpatient care at BWH and ambulatory care
at DFCI. The BMT/Hematology/Oncology service at BWH comprises 65 beds
divided among five pods. Each pod can accommodate patients in various
stages of chemotherapy, radiation, BMT, and post-transplant
complications. After three to six weeks of inpatient transplant
treatment, the patient receives ongoing care at DFCI.
At the beginning of the transplant procedure, nurses at DFCI start
teaching patients from materials containing extensive information on
each stage of transplant. Judy Rumble, RN, BSN, is the nurse in charge
on 4C. She notes that patients come in quite well informed but have
the opportunity to continue learning about their treatment because BWH
provides a laptop computer for each, while a resource team is
available to help them find any information they want.
Cynthia M. Jodoin, RN, BSN, nurse manager of BMT/Hematology/Oncology,
says, "The people who elect to have transplants are very committed to
their therapies, compliant with treatment, and receptive to the nurses
teaching them to care for themselves." Jodoin observes that transplant
patients are under so much stress that they can be overwhelmed
physically, emotionally, and spiritually. One of the most beneficial
aspects of treatment to counteract that stress is the relationship the
primary nurse forms with the patient. Jodoin says, "Building
relationships is the essence of nursing, and the relationships the
nurses build here are intense."
Christine Davie, RN, BSN, staff nurse on 6C, knows that the patient
has already experienced severe illness and extensive treatment before
admission. Many people are also afraid, she observes, of not being
seen as an individual in a large, metropolitan hospital. In this
population, patients experience a long separation from home, family,
work, and sometimes country. "Our role is to be a huge support from
the moment the patient walks in," Davie says. "I view support as
helping the patient and family get through the [daily] anxiety and
symptoms." Davie helps her patients focus on priorities by telling
them, "This is what we are going to do for today." Rumble reinforces
that everyone is different, and advises her patients, "Take it one day
at a time and you will make it." Jodoin makes sure that family members
feel involved and comfortable by helping them find housing, parking,
or other services. "Within our BMT/Hematology/ Oncology service, we
are like a small town in the big city," Davie says.?
http://bostonworks.boston.com/healthcare/articles/oncall_200507b.html
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Other Useful Information
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Here is a forum of family and patients who have undergone mini-BMTs.
You may gain some insight here:
http://aplasticcentral.com/aplastic/toast.asp?sub=show&action=posts&fid=2&tid=288
Another support forum, in Ireland
http://www.bmtsupport.ie/
I?d also recommend ordering this book, Bone Marrow and Blood Stem Cell
Transplants: A Guide for Patients by Susan K. Stewart with Jan Sugar,
$8.95 USD)
http://www.bmtinfonet.org/transplanthandbook.html
Medical Jargon-buster:
http://aafa-ner.org/aa-mds/mysteries.html
This eMedicine site has a staging page which may help you understand
the severity of MDS
http://www.emedicine.com/med/topic2695.htm
There are links to journals of 3 transplant patients on this page,
last row. Knowing other?s stories can help prepare your brother.
http://www.nhlcyberfamily.org/stories.htm
What to bring to the hospital.
The most important tip on this site is an electric razor! No blades
for patients prone to infection!
http://www.nhlcyberfamily.org/hospital.htm
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***If you are a person who prays, please read on., If not, skip the following:
Pastoral Care at Dana-Farber: ?Chaplains from Dana-Farber Cancer
Institute offer religious and/or spiritual support 24 hours a day for
you and your family. Clinically trained chaplains from a variety of
perspectives, including interfaith, Islamic, Jewish, Protestant, and
Roman Catholic, are available to meet with you before, during, and
after treatment.?
By Phone: (617) 632-3908.
By Pager: (617) 632-3352, ID#41546
By E-Mail: walter_moczynski@dfci.harvard.edu
http://www.dana-farber.org/pat/support/pastoral_dfcihome.asp
?Most research in the field looks at how people who are sick are
affected by their own spiritual beliefs and practices. In general,
these studies have suggested that people who are religious seem to
heal faster or cope with illness more effectively than do the
nondevout.?
http://archives.cnn.com/2000/HEALTH/alternative/01/18/prayer.power.wmd/
http://www.time.com/time/columnist/jaroff/article/0,9565,193084,00.html
http://www.christianexaminer.com/Articles/Articles%20Jan05/Art_Jan05_04.html
http://www.wired.com/wired/archive/10.12/prayer.html
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To summarize, of the three hospitals - Fred Hutchinson, Dana-Farber,
and Rocky Mountain, Dana-Farber has conducted the largest number of
mini-BMTs. I found no negative information on Dr. Richard M. Stone; On
the contrary, I found nothing but article and reports that portray him
as a stellar physician. He is highly published, has run clinical
studies on BMTs and conducts research on MDS and other
lymphoproliferative diseases on a continuing basis. Should you
purchase the Healthgrades report, you may find something, but I
seriously doubt it.
Although the quality of care you will receive at Dana ?Farber is
reason enough to make a decision, the weather in Seattle is probably
rainy and overcast a lot, and your brother has memories of friends who
died there. You have family in Boston, and your brother seems to like
and respect Dr. Stone?s medical opinions. The quality of nursing care
is excellent, judging by the awards Dana-Farber nurses have won. I
would have no hesitation whatsoever in selecting Dana-Farber as your
hospital of choice. Follow-ups in Denver seem logical, once your
brother is stabilized. I?m certain that you will achieve some peace of
mind once you arrive at a final decision regarding the hospital and
doctor, allowing you to concentrate on your brother?s well-being.
One more thing; While you are gathering all your facts, try to avoid
letting the MDS take over your brother and the family. Don?t forget
your brother is not his disease. (I?m not saying you ARE doing this,
mind you). Go to the movies, take part in family activities, discuss
current events, and try to carry on as normally as possible. He will
be immersed in the disease when he gets to the hospital.
I send my sincerest best wishes.
If any part of this answer is unclear, please request an Answer
Clarification, before rating. I will be happy to respond!
Regards, Crabcakes
Search Terms
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nonmyeloablative transplant
nonmyeloablative transplant + success rate + MDS
Dr. Richard Stone + nonmyeloablative transplant
nonmyeloablative transplant + Dana-Farber + MDS
Graft vs. Disease
mini-bmt
mini-BMT + success rate + MDS
adoptive immunotherapy |
