In the weeks prior to your stem cell transplant, your conditioning regimen will be established. During this time, you will meet your doctor and transplant specialist to be provided with services and support. Your general health will be evaluated and the status of your disease will be reviewed. This ensures that you are physically and mentally ready for the transplant procedure.
This conditioning therapy helps the body properly prepare for the cells that it is about to receive. Let’s learn more about this necessary and highly critical event that must transpire prior to transplantation.
Why is a Conditioning Regimen Important?
Conditioning therapy is imperative to eliminate as many cancer cells in the body as is possible prior to the stem cell transplant. The conditioning regimen is a process where a very high dose of chemotherapy – that may or may not be accompanied by radiation treatment – is given in order to wipe out cancerous cells.
Considered to be toxic, these treatments also destroy the body’s stem cells. While this process may be viewed as “harsh” and may be a bit uncomfortable for patients, it is necessary so that when the stem cell transplant is performed, it has a higher chance of successfully “taking”.
Options That May be Considered for the Conditioning Regimen for Stem Cell Transplant
Your doctor may consider many options for you when it comes to your conditioning regiment. The first is whether or not radiation will be used in conjunction with chemotherapy in order to destroy the stem cells and the cancer cells within the body.
If radiation is used, it may be broken down into small doses over the course of several days. This is referred to as being “fractionated” and helps to decrease the overall level of toxicity.
The next is whether the conditioning process will last one week or two. Finally, it will be decided whether or not Monoclonal antibodies will be introduced to the body during the process. An example of such an antibody is Rituxan.
Total Body Irradiation
Often referred to as “TBI”, total body irradiation is a specific type of radiation therapy that will treat the entire body. When this type of radiation therapy is performed, it is given to you in low doses and several times throughout a 24-hour period.
This type of treatment is typically provided for as few as three days or for as many as five days. While this aids in killing off the cancer cells that are throughout the body, the primary purpose of the treatment is to properly suppress the immune system so that the stem cell transplant is successful.
A team that consists of radiation oncologists, physicists, radiation therapists, and several other medical professionals will gather to determine what amount of radiation is appropriate for your needs.
There may be a need for other medical procedures to be performed when whole-body radiation is used in order to reduce the effects of the intense exposure to radiation.
An example of these procedures includes those that spare the lungs and help reduce side effects. Once the treatment plan is completely outlined, you will be scheduled for radiation delivery.
Reduced Intensity Conditioning
Reduced intensity conditioning (RIC) utilizes significantly less chemotherapy and radiation therapy in a patient than is standardly given prior to a stem cell transplant for your conditioning regimen.
This is done to decrease complications associated with the stem cell transplant and the level of toxicity in which a patient experiences.
While often most comfortable for a patient, there may be a higher risk of the body rejecting the stem cell transplant. But it is ideal for those with severe pre-existing health issues and older patients.
Depending on how much of a reduction is issued, one may be able to receive this type of therapy on an outpatient basis and not have to remain in the hospital.
This is done to suppress the immune system so that the donor stem cells are able to successfully take over the bone marrow in the body. This process is called “engraftment”.
If there is successful engraftment, the immune system of the patient will then be able to combat the remaining cancer cells within the body. This effect is referred to as “graft-versus-tumor”.
The following outlines the general eligibility requirements for patients to be given the reduced intensity conditioning regimen:
- A patient must have an immune deficiency or defects pertaining to the failure of bone marrow
- A patient must have pre-leukemia syndrome
- A patient must either be in the first remission of acute myeloid leukemia or in the chronic phase of chronic myeloid leukemia
- A patient must have certain types of metabolic health disorders – such as Hurler’s disease
- A patient must have dysfunction of the lung combined with acute leukemia or must have dysfunction of the kidney or heart and have had a previous complication with treatment and/or illness that was life-threatening
- NOTE: A patient must only meet one of the previously outlined criteria to be able to engage in reduced intensity conditioning therapy.
Once the conditioning regimen is finished, the stem cell transplant takes place and recovery is initiated. You may have a highly intense outpatient stay or you may have an inpatient stay. This typically lasts at least 12 days and may go as long as 30 days or more.
This stay depends upon just how long it will take the new stem cells to successfully engraft and start making new blood cells once it is in the bone marrow. It is during this time that the white blood cell count is very low. As a result of this fact, the risk for developing an infection is very high.
To aid in preventing infections during the recovery process, you will be provided with medications that help to prevent infections. These are called “prophylactic antimicrobials”.
While this is an effective preventative measure, the risk for infections remains very high until the stem cells from the transplant have been able to go through the process of regenerating the white blood cells. This can take up to four weeks. The overall recovery time that is experienced is unique to the patient.
While going through the conditioning therapy process and beyond for stem cell transplant, you may be referred for physical therapy. This branch of medicine has been highly advocated as being promising when utilized in adjunct to therapies before and after stem cell transplantation.
Physical therapists may help in strengthening the body, the function of a patient’s lungs, improving their level of endurance, and optimizing a patient’s overall quality of life.
Each patient is unique; therefore, their physical therapy regiment will also be unique.
If you are the patient, you should know that the type of physical therapy you receive, the frequency of the therapy, the intensity of the exercises, and the duration in which you participate will be based on your needs and your health. Your program will be different than other patients.
The Need for Physical Therapy for Stem Cell Transplant Patients
As a stem cell transplant patient, you are well aware of the fact that the procedure presents a wide variety of complications – many of which may be extremely severe – that may occur before, during, and after treatment.
You must receive standardized and highly structured care that will aid in the detection of musculoskeletal issues as quickly as possible.
You must also be evaluated frequently to ensure the timely intervention should functional-based loss start to occur within the body.
Physical therapy helps with all of this.
Additionally, physical therapy helps in the following way for stem cell transplant patients:
- It will help to ensure that you get the services that you require, as an individual
- You will find that you spend less time going through the recovery process
- You will receive continuous care that is high in quality, per your needs
- It is a cost-effective means of ensuring the transplant and the recovery process is successful
- It allows the medical community to research stem cell transplant patients and to collect and utilize data that will benefit future patients that must undergo stem cell transplants
Physical Therapy and Adverse Effects of Stem Cell Transplantation
Stem cell transplants have the capability of causing profound and long-lasting adverse effects on a patient’s mental and physical well-being. The transplant process will result in a decline in your physical functioning. This comes from the loss of muscle mass and general levels of muscle strength.
Additionally, muscle atrophy occurs as a result of the immunosuppressive therapy, the amount of bed rest that you must indulge in, as well as toxicities from drugs that you will be given before, during, and after the stem cell transplant.
Furthermore, the isolation and the risk of experiencing an illness that could be fatal will result in high levels of fatigue, depression, and other issues. These, too, may result in the development of issues with physical functioning.
The chemotherapy that is issued prior to the stem cell transplant could result in anemia. This causes issues with the cardiorespiratory fitness levels and may also result in weakness to the muscles and the onset of atrophy.
If radiation therapy is used in the treatment process, it could result in a decrease in lung function.
Furthermore, neurological function, heart function, issues with the endocrine system, and the development of osteoporosis may occur.
All of these adverse effects either alone or together will have a detrimental impact on physical function; however, physical therapy helps to offset this impact.
When you have a stem cell transplant, your activity will be restricted.
The amount of exercise that you are able to perform will be extremely limited. You will need to maintain physical functioning through the conditioning regimen and the treatment process. You may find that you struggle to achieve the required physical functioning that is necessary for the procedure to be successful.
This is where physical therapy will come into play.
The therapist that you work with will be able to create a customized exercise plan – based on your specific limitations and your individual needs – which will permit the highest level of success when it comes to your healing and recovery.
By integrating physical therapy as early as the conditioning therapy process, the treatment will be a much larger success than if you elected not to engage in physical therapy.
The Follow-Up Process
The recovery process – in completion – may take up to a year. Once you are at home in the post-engraftment process, you will need to continue to work to build up the body and prevent infections.
If you have a central line that remains in place, this will need to be flushed regularly with saline and the point of insert will need to be cleaned on a regular basis.
You will need to continue to work with your care team and the physical therapist to boost your chance of having a highly successful recovery.
If you notice anything unusual or of concern, contact your doctor immediately.
Let Us Help
We here at Back to Motion Physical Therapy are familiar with the stem cell transplantation process and all that patients must undergo in order for the procedure to be a success. We are willing to work with you – one-on-one – to create a care plan that will help you stay strong before, during, and after the process.
With our customized care plan, you will find that you feel stronger, experience fewer illnesses, and have the highest likelihood of making it – successfully – to the one-year mark.
If you would like more information on this or would like to set up an appointment, contact us today.