在过去的10年里,癌症治疗的进步和支持治疗的改善改善了干细胞移植的结果和耐受性. 然而,干细胞移植仍然是一个复杂和潜在危险的过程. For autologous transplantation, 患者接受自己的骨髓或干细胞,这些干细胞是在接受大剂量化疗或放疗前收集和冷冻的.
自体移植
准备
移植前评估
干细胞移植专家将通过回顾你的医疗记录和病史来开始评估, performing a physical exam 和 discussing the procedure with you. 如果你的十大赌博平台排行榜认为你适合自体干细胞移植, he or she will recommend a treatment plan.
提前进气测试
Before being admitted to the hospital, 你将有几天的实验室和其他诊断测试来确定你的心脏功能是否正常, 肺, kidney 和 liver 和 that you do not have an undiagnosed infection. 在你入院之前,这些检查大部分都是作为门诊病人进行的, but others may need to be completed after you are admitted for treatment. 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
- Pulmonary function tests (PFTs)
- Computed tomography (CT) scan
- Electrocardiogram (EKG or ECG)
- Cardiac scan or echocardiogram
- 鼻窦x射线
- 腰椎穿刺
干细胞收集
干细胞主要存在于骨髓中,但也可以通过刺激进入血液. When the stem cells are collected from the hip bone via many bone marrow aspirations, which are usually performed in the operating room, the transplant procedure is called a bone marrow transplant. This is very rarely done these days. 当用一种叫做G-CSF的激素刺激干细胞后,从血液中收集干细胞, or a novel agent called prelixafor, the transplant is called a peripheral blood stem cell transplant. 目前,大多数移植手术包括从外周血中收集干细胞.
When bone marrow or blood stem cells are infused into the patient, 它们通过静脉导管(IV)或中心静脉导管进行施用, just like a blood transfusion. The stem cells are not administered directly back into the bone, but travel to the bones from the blood stream.
For more information, visit the 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
在你入院后不久,干细胞收集后,化疗就开始了. Your doctor will discuss all of the drugs you will receive 和 their side effects. 你的执业护士、住院护士和药剂师也会回答你的问题. In addition, you may receive written information on these drugs in a consent form.
Some precautions are taken to minimize side effects from these drugs. 例如, when receiving some types of chemotherapy, 患者必须每天彻底淋浴两次,以清除通过皮肤排出的药物,这样做有助于防止或减少化疗烧伤. The inpatient nurse will go over any special precautions that you may need to take. 你的十大赌博平台排行榜也可能在入院前讨论药物治疗(palifermin)以防止一些移植相关的并发症.
全身照射
Some patients receive total body irradiation (TBI) in addition to chemotherapy. 这种放射疗法旨在摧毁残留的癌细胞,进一步抑制免疫系统.
创伤性脑损伤的治疗在放射治疗部门进行,通常持续三到四天. The treatment itself is painless, but there may be uncomfortable side effects after treatment, such as mouth 和 throat sores, 恶心想吐, stomach 和 intestinal irritations, 皮肤发红. Anti-恶心想吐 medication is usually given before each treatment to reduce 恶心想吐. You may receive additional medication (palifermin) to prevent mouth sores.
移植程序
移植手术将在你最后一次化疗后的一到三天内进行,或者在你最后一次放疗后的任何时间进行. The day of transplantation is referred to as Day 0. 移植前的天数为负天数,移植后的天数为正天数.
这个过程类似于简单的输血,将在你的病房里进行. You may have a family member in the room with you if you wish. 根据干细胞的大小,实际的过程大约需要45分钟. If you are receiving bone marrow, the infusion may take several hours. The blood stem cells will be infused through your central venous catheter.
Your nurse will check your blood pressure, 温度, 呼吸和脉搏, 和 will watch for any side effects. Usually there are no side effects, but occasionally patients may experience a funny taste in the mouth, 发冷, 脸红, 恶心和呕吐, 头疼, 和 changes in blood pressure 和 breathing.
等待移植
The new bone marrow does not recover immediately after it has been transplanted. The stem cells of the transplanted marrow will travel to the bones, 重新播种骨髓空间,在成熟细胞从骨髓释放到血液之前经历一个生长过程. 从移植那天起,你的骨髓需要8到14天才能开始产生白细胞, red blood cells 和 platelets.
移植这个术语用来描述你的新骨髓何时开始发挥功能并产生细胞. 在等待移植的过程中,没有成熟细胞离开骨髓进入血液. 你的血球计数将显示非常低的数值,你将需要由健康护理小组仔细监测. 我们的目标是为你提供红细胞和血小板,直到你再次产生细胞.
For more information, visit the Blood Counts 和 Transfusions 部分 自体移植指南.
复苏
延迟性副作用
人体在移植后大约一周会感受到化疗或放疗的影响. 当血液计数低时,你会觉得自己得了流感,可能不想做太多事情. This will last for about two weeks 和 will decrease as your blood counts improve. You may notice a number of other symptoms as well, including:
- 食欲不振
- 恶心和呕吐
- 视力变化
- 口腔和喉咙疼痛
- 腹泻
- Difficulty sleeping 和 fatigue
- 感染
- 脱发
- 皮肤反应
- 移植物抗宿主病
Find detailed information about these side effects in the 治疗 部分 自体移植指南.
Preparing to leave the hospital
当你的中性粒细胞计数超过1000时,你的团队会开始和你讨论出院的问题. 你需要确保在你出院后有人陪着你, to assist you with daily needs 和 to be available for clinic visit transportation. You or a family member will learn how to care for your catheter.
To be discharged, you will need to be:
- 走
- Eating at least 1,000 calories daily
- Drinking at least one quart of fluid daily
- Free of active medical problems
- 不发烧
- Off intravenous medications 和 taking your pills without problems
- Show that you can care for your intravenous catheter if it is needed after discharge
The case manager will assist with arrangements for home care. 执业护士会检查你的出院和门诊指示,药剂师会和你一起检查你的药物.
常规门诊就诊
移植后,您的BMT十大赌博平台排行榜和执业护士将密切关注您. 你会做血液检查,如果有必要,还会接受静脉注射药物或液体.
保持健康
在自体骨髓移植后的至少三个月内,你的感染风险仍将高于正常水平, even though your body is again producing white blood cells. 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, which is called house arrest. You will be instructed on how to help prevent infection, 包括洗手, avoiding large crowds 和 refraining from smoking.
Get more information about taking care of yourself after a BMT in the 门诊医疗 部分 自体移植指南.
加州大学旧金山分校健康 medical specialists have reviewed this information. 它仅用于教育目的,并不打算取代您的十大赌博平台排行榜或其他医疗保健提供者的建议. 我们鼓励您与您的供应商讨论您可能遇到的任何问题或疑虑.