A National Cancer Institute Comprehensive Cancer Center

 
 

Cancer Care

 

 

Treatment

We strive to provide a relaxed, caring environment to better serve the health care needs of our patients. We know that emotional and mental well-being is as important to healing as the treatment itself.

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Special Programs

Norris Cotton Cancer Center offers one of the only programs in northern New England to provide transplants in which the patient receives their own blood and/or bone marrow (autologous) as well as transplants in which the patient receives blood and/or bone marrow from someone else, possibly a relative (allogeneic). We are the only National Marrow Donor Program (NMDP) transplant center in northern New England and are recognized as a specialized center for unrelated donor transplants.

Outpatient Treatment

Our outpatient treatment program recognizes that a blood and marrow transplant is difficult for patients and requires a lengthy commitment to hospital-based treatment. Whenever possible, we will offer a treatment option that allows patients to stay either at home or in a nearby hotel rather than requiring patients to stay overnight in the hospital. A blood and marrow transplant requires an average of 21 consecutive days, but only 3 – 6 hours each day are spent in actual treatment. Rather than spending the rest of the time in the hospital, we encourage patients to stay at home if possible, or in one of several local hotels that make special arrangements for BMT patients. This provides increased privacy and quiet time and can make the treatment less unpleasant.

For more information about outpatient treatment, please read these articles in Dartmouth Medicine and in Focus.

Cell Collection

Collecting blood stem cells for transplant can happen in one of two ways:

Apheresis: Apheresis is the process of taking blood from a donor, separating and collecting blood products (in this case, blood stem cells), and returning the rest back to the donor. A tube or catheter is inserted (usually into a vein in the arm) and blood is removed and run through a machine that removes the stem cells. The rest of the blood is returned to the patient. There is usually no need for hospitalization or anesthesia. Typically, apheresis takes five hours and is usually done twice for each patient.

Apheresis is the preferred method for extracting blood stem cells because it is easier, less painful and intrusive for the patient, and less expensive.

Bone marrow aspiration: Aspiration is the process of removing marrow from inside bones so that the blood stems cells in the marrow can be extracted and subsequently transplanted. Aspiration is performed in an operating room and requires that the patient have general anesthesia. During the process, a needle is inserted into several locations in the hip and pelvis, and bone marrow is suctioned out. An aspiration treatment takes about two hours and usually does not need to be repeated.

Chemotherapy

There are usually multiple courses of chemotherapy associated with a blood and marrow transplant. The first course, cytoreduction chemotherapy, reduces the number of cancer cells to a level that permits the process to go forward. Once the doctor determines that the level is low enough, the transplant process proceeds and the blood stems cells are extracted from the patient in an autologous transplant.

Once the blood stem cells have been collected, the second, high-dose course of chemotherapy is performed. This course is sufficient to kill all the cancer cells and also destroys the bone marrow, necessitating the infusion of blood stems cells. The number of chemotherapy sessions that are required is different for every patient.

Extracorporeal Photopheresis

In each photopheresis procedure, a small portion of the patient's white blood cells is collected, treated with a medicine (methoxsalen) that is then activated by brief exposure to UVA (ultraviolet-A) light, and then promptly returned to the blood stream.

Transplantation

Once the high-dose chemotherapy is complete, and after a day of rest, the stem cells that were collected earlier are infused into the patient. The infusion takes less than half an hour and is usually complete in one or two sessions. The patient is monitored over the next two or three weeks until "engraftment" occurs: the body begins making its own blood cells again. At this point, the stem cells that were infused have reestablished in the bone marrow and have begun to produce new blood cells. Once engraftment has occurred, the patient is discharged and returns home.

Follow-up

Patients are monitored every week or two until 100 days after the transplant. At that time they are completely re-evaluated to verify that the process has worked. Periodic checkups are required every six months for the first two years, then annually thereafter.