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Medical oncologists at Hahnemann University Hospital performed one of the region’s first bone marrow transplants in 1976, bringing groundbreaking treatment and new hope to cancer patients. This tradition of innovation and excellence continues today, as our medical oncologists advance care for patients with solid tumors and blood diseases such as leukemia, lymphoma and myeloma.
For many patients, the medical oncologist is the primary provider of cancer care. The oncologist assembles diagnostic information and consults with pathologists, surgeons, radiation oncologists and specialists in transfusion medicine to ensure that each patient receives a comprehensive treatment plan that is tailored to their precise needs. The oncologist then oversees each step in the plan, acting as the coordinator of care. Medical oncologists also prescribe chemotherapy, monitor patients during their treatment and help them to overcome any side effects. After the treatment plan is completed, oncologists continue to follow patients during regularly scheduled visits for routine reassessments. Oncologists are also active in preventive care and offer cancer screening, risk factor counseling and genetic testing when appropriate.
Our oncologists are on the cutting-edge of emerging cancer treatments and collaborate with researchers at Johns Hopkins University, the Eastern Cooperative Oncology Group, National Cancer Institute, the Central Pennsylvania Oncology Group and the Cancer Trials Support Unit. In addition, we are one of only 21 national centers to be designated a Center of Excellence by the Myelodysplastic Syndrome Foundation. Whenever possible, our patients are enrolled in these sophisticated clinical treatment protocols, providing them with access to promising new cancer therapies.
Chemotherapy
Chemotherapy is the use of chemical agents to destroy cancer cells. It came into use in the 1950s and is now a mainstay of care, with more than half of cancer patients receiving this form of treatment.
How Chemotherapy Works
Cancer cells divide rapidly. Chemotherapy is designed to target fast-dividing cells. Because it is administered by mouth, through a vein, or into a muscle, chemotherapy is considered a “whole body” treatment that can destroy cancer cells that may have spread anywhere in the body, including areas far from the original disease site. New forms of chemotherapy are administered directly into tumors using small tubes or catheters. This method delivers the medication directly to the area of greatest concern, with the goal of increasing its effectiveness.
Chemotherapy Administration Strategies
Chemotherapy is typically administered in cycles. This destroys tumor cells and then gives the body time to recover. Usually, the treatment lasts from three to six months.
Chemotherapy treatments are categorized in the following ways:
- Combination chemotherapy
Combines agents with different anti-cancer actions. This helps to reduce side effects and maximize the therapeutic effect. Also, since cancer cells can become resistant to chemotherapy medications, using different drugs can reduce resistance and result in an improved treatment outcome
- Adjuvant chemotherapy
Adjuvant chemotherapy is administered after surgery. This approach is used when there is an increased risk of cancer recurrence to reduce the risk of a relapse.
- Neoadjuvant chemotherapy
Chemotherapy that is given before surgery. This shrinks the tumor, enabling the surgeon to perform a less invasive procedure and/or remove all visible tumor.
- Combined modality chemotherapy
Chemotherapy that is used along with surgery or radiation therapy. These combined approaches increase the likelihood of treatment success. Today, most patients are treated using a combined approach.
Chemotherapy and Side Effects
Because chemotherapy affects rapidly-dividing cells, it also affects normal cells that divide quickly. These include hair, blood, and skins cells as well as those lining the gastro-intestinal tract. As a result, the most common side effects of chemotherapy are hair loss, skin changes, nausea, diarrhea and appetite changes. However, newer medications to prevent nausea and diarrhea and to promote the growth of blood cells have helped to control these side effects.
Monitoring Patient Health During Chemotherapy
Since chemotherapy affects the blood cells, patients are carefully monitored during treatment. Blood studies include:
- White blood count (WBC)
White blood cells help to fight infection. A normal WBC is between 4,000-11,000 in adults. A low white blood cell count, known as neutropenia, means that the patient’s immune system is not as strong as it could be and makes the patient more susceptible to infection.
- Platelet count
Platelets are blood cells that help the blood to clot, preventing potentially serious bleeding when an injury occurs. The normal adult platelet count is 150,000-300,000. A low count, known as thrombocytopenia, places patients at risk of bleeding. To prevent bleeding, chemotherapy patients are advised to shave with electric razors rather than blades; use a soft-bristled toothbrush; avoid contact sports and medications such as aspirin or ibuprofen (Tylenol) that may promote bleeding. When the platelet count is too low, or when bleeding occurs, a platelet transfusions is administered to correct it.
- Hemoglobin
This is the part of the red blood cell that carries oxygen to the tissues. Normal levels are 12-16 for adult females and 14-18 for adult males. Low levels of hemoglobin can cause fatigue, chest pressure or breathing difficulties. Any of these symptoms should be reported to the health care team.
When patients have an extremely low count for any of the above studies, the physician may delay further chemotherapy or reduce the dosage to give the body a chance to produce additional blood cells.
Bone Marrow Transplantation
Bone marrow is a spongy material in the hollow center of large bones, such as those in the hip and thigh. It produces immature cells, called stem cells. These cells develop into oxygen-carrying red blood cells, infection-fighting white blood cells, and blood-clotting platelets that prevent life-threatening bleeding.
Indications for Bone Marrow Transplantation
There are two general indications for a bone marrow transplant (BMT). One is to provide healthy new blood cells to patients with leukemia, lymphoma, multiple myeloma, or myelodysplasia.
The second indication is to restore blood cells that have been wiped out by high doses of chemotherapy or radiation therapy. Although these treatments are useful in destroying cancer cells, they can also reduce the number of blood cells available to carry blood and oxygen and fight infection. When this occurs, a transplant of new bone marrow is used to help restore a healthy immune system. Bone marrow may be donated in advance of the initial treatment by patients themselves, by a relative, or by someone with a matching tissue type.
Kinds of Bone Marrow Transplants
- Autologous
Donor cells are taken directly from the patient and frozen for later use. The patient then receives high-dose chemotherapy and/or radiation therapy as a part of their cancer therapy. This is a treatment that is frequently used for patients with Hodgkin’s disease, non-Hodgkin’s lymphoma, multiple myeloma and some tumors.
- Allogeneic transplant
New bone marrow cells come from a related or unrelated donor with a matching tissue type.
- Haploidentical
For patients age 30 and younger. This protocol is offered in partnership with Johns Hopkins University, Eastern Cooperative Oncology Group, and the National Cancer Institute. It makes bone marrow transplantation available to patients without a related or unrelated matched donor.
- Mini-Allogeneic
Less intensive transplants may be used for older patients or those with health problems that rule out a standard bone marrow transplant.
The Bone Marrow Transplant (BMT) Procedure
During an operating room procedure under general anesthesia, bone marrow is withdrawn through a needle inserted into the patient’s or donor’s hip.
The bone marrow recipient is hospitalized. Because patients become highly vulnerable to infection during the bone marrow transplant, they receive care in a private hospital room. These rooms are equipped with a special air filtration system called laminar flow which reduces the chance of infection and enhances recovery.
The harvested bone marrow is infused into a vein using an I.V., and the new marrow travels to large bones such as the breast bone, skull, hip, ribs and spine. After several weeks, it begins producing normal blood cells.
The information on these pages is provided for general information only and should not be used for diagnosis or treatment, or as a substitute for consultation with a physician or healthcare professional. If you have specific questions or concerns about your health, you should consult your healthcare professional.
To make an appointment, call 866-884-4HUH (4484)
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