Medical Oncology & Bone Marrow Transplant

What is Medical Oncology?

Medical Oncology is a modality of treatment in cancer care which uses Chemotherapy, Immunotherapy, Hormonal Therapy and Targeted Therapy to treat cancer in an effective manner. Medical Oncology is usually works in conjunction with Surgical Oncology or Radiation Oncology to give the best clinical outcomes.

In addition to Chemotherapy, the department also runs protocols and specialises in out-patient and ambulatory chemotherapy. Our medical oncology service includes treatments for solid tumours, specialized outpatient chemotherapy with chemoports and hematological neoplasm in adults and children.

Chemotherapy

Chemotherapy is a type of cancer treatment that uses drugs to destroy cancer cells. Chemotherapy works in a pattern of stopping or slowing the growth of cancer cells, which grow and divide quickly. But it can also harm quickly dividing healthy cells, such as those that lie in the mouth and intestines or cause hair to grow. Damage to healthy cells may cause side effects.

Often, side effects get better or go away after chemotherapy is over. Chemotherapy is divided into two categories Neoadjuvant and adjuvant chemotherapies. Neoadjuvant chemotherapy is a type which is delivered before surgery or radiotherapy, while Adjuvant Chemotherapy is delivered after the surgery or radiotherapy. Chemotherapy may be used to destroy cancer cells that have come back (recurrent cancer) or spread to other parts of the body (metastatic cancer). Earlier, there used to be less number of chemotherapy drugs but today, we have several options of giving 1st, 2nd, and 3rd line drugs. Low dose metronomic chemotherapy is also showing some promising results.

Immunotherapy

Immunotherapy is a breakthrough innovation in Cancer Care. Immunotherapy is the process of activating the immune cells to fight against cancer cells it is a personalised treatment which intends to enhance the body’s defence mechanism to combat and destroy cancer cells. Immunotherapy uses the cells made by the patient’s own body, or treatments made in a laboratory to improve or restore immune system function.

The reprogramming of the immune system in a patient’s body is done through three ways, personalised to the specific cancer condition, namely – Drug therapy, Dendritic cell therapy and Cancer Vaccines. In the first type, the drugs induced boost the antibodies to destroy cancer cells. Dendritic cell therapy involves the usage of T-cells, the cells which fight infection, are removed from the blood, later modified in laboratory and injected to the patient’s body to treat cancer cells. Cancer vaccines when injected, triggers the immune system to recognize and destroy that antigen or related materials, thus killing the cancer cells and put an end to their progress.

Targeted Therapy

Targeted therapy is a cancer treatment that uses drugs and is completely different from the traditional chemotherapy. The modality known as targeted therapy helps in stopping the cancer from growing and spreading to other organs. They work in a pattern of targeting the specific genes or proteins. These genes and proteins are found in cancer cells or in other cells which could be related to cancer growth, like blood vessel cells.

Hormone Therapy

Some cancers use hormones to grow or develop, which means the cancer is hormone sensitive or hormone dependent. Hormone therapy for cancer uses medicines to block or reduce the amount of hormones in the body to stop or slow down the growth of cancer. Hormone therapy stops hormones from being developed or prevents hormones from making cancer cells grow and divide.

Cancers that can be hormone sensitive include:

Bone marrow transplant:

A bone marrow transplant is a procedure that infuses healthy blood stem cells into your body to replace your damaged or diseased bone marrow. A bone marrow transplant is also called a stem cell transplant.

A bone marrow transplant may be necessary if your bone marrow stops working and doesn’t produce enough healthy blood cells.

Bone marrow transplants may use cells from your own body (autologous transplant) or from a donor (allogeneic transplant).

Why it’s done
A bone marrow transplant may be used to:

Bone marrow transplants can benefit people with a variety of both cancerous (malignant) and noncancerous (benign) diseases, including:

Risks:

A bone marrow transplant poses many risks of complications, some potentially fatal. The risk can depend on many factors, including the type of disease or condition, the type of transplant, and the age and health of the person receiving the transplant. Although some people experience minimal problems with a bone marrow transplant, others may develop complications that may require treatment or hospitalization. Some complications could even be life-threatening.
Complications that can arise with a bone marrow transplant include:

Graft-versus-host disease: A potential risk when stem cells come from donors

There are two kinds of GVHD: acute and chronic. Acute GVHD usually happens earlier, during the first months after your transplant. It typically affects your skin, digestive tract or liver. Chronic GVHD typically develops later and can affect many organs.

GVHD may happen at any time after your transplant. However, it’s more common after your bone marrow has started to make healthy cells.

Many people who have an allogeneic transplant get GVHD at some point. The risk of GVHD is a bit greater if the stem cells come from an unrelated donor, but it can happen to anyone who gets a bone marrow transplant from a donor.

If you receive a transplant that uses stem cells from a donor (allogeneic transplant), you may be at risk of developing graft-versus-host disease (GVHD). This condition occurs when the donor stem cells that make up your new immune system see your body’s tissues and organs as something foreign and attack them.

Chronic GVHD signs and symptoms include:

How you prepare

Pre-Transplant tests and procedures

You’ll undergo a series of tests and procedures to assess your general health and the status of your condition, and to ensure that you’re physically prepared for the transplant. The evaluation may take several days or more. In addition, a surgeon or radiologist will implant a long thin tube (intravenous catheter) into a large vein in your chest or neck. The catheter, often called a central line, usually remains in place for the duration of your treatment. Your transplant team will use the central line to infuse the transplanted stem cells and other medications and blood products into your body.

Collecting stem cells for transplant

If a transplant using your own stem cells (autologous transplant) is planned, you’ll undergo a procedure called apheresis (af-uh-REE-sis) to collect blood stem cells. Before apheresis, you’ll receive daily injections of growth factor to increase stem cell production and move stem cells into your circulating blood so that they can be collected. During apheresis, blood is drawn from a vein and circulated through a machine. The machine separates your blood into different parts, including stem cells. These stem cells are collected and frozen for future use in the transplant. The remaining blood is returned to your body.

If a transplant using stem cells from a donor (allogeneic transplant) is planned, you will need a donor. When you have a donor, stem cells are gathered from that person for the transplant. This process is often called a stem cell harvest or bone marrow harvest. Stem cells can come from your donor’s blood or bone marrow. Your transplant team decides which is better for you based on your situation. Another type of allogeneic transplant uses stem cells from the blood of umbilical cords (cord blood transplant). Mothers can choose to donate umbilical cords after their babies’ births. The blood from these cords is frozen and stored in a cord blood bank until needed for a bone marrow transplant.

The conditioning process

After you complete your Pre-Transplant tests and procedures, you begin a process known as conditioning. During conditioning, you’ll undergo chemotherapy and possibly radiation to:

The type of conditioning process you receive depends on a number of factors, including your disease, overall health and the type of transplant planned. You may have both chemotherapy and radiation or just one of these treatments as part of your conditioning treatment.

Side effects of the conditioning process can include:

You may be able to take medications or other measures to reduce such side effects.

Reduced-intensity conditioning:

Based on your age and health history, your doctor may recommend lower doses or different types of chemotherapy or radiation for your conditioning treatment. This is called reduced-intensity conditioning. Reduced-intensity conditioning kills some cancer cells and somewhat suppresses your immune system. Then, the donor’s cells are infused into your body. Donor cells replace cells in your bone marrow over time. Immune factors in the donor cells may then fight your cancer cells.

What you can expect

During your bone marrow transplant

Your bone marrow transplant occurs after you complete the conditioning process. On the day of your transplant, called day zero, stem cells are infused into your body through your central line. The transplant infusion is painless. You are awake during the procedure. The transplanted stem cells make their way to your bone marrow, where they begin creating new blood cells. It can take a few weeks for new blood cells to be produced and for your blood counts to begin recovering. Bone marrow or blood stem cells that have been frozen and thawed contain a preservative that protects the cells. Just before the transplant, you may receive medications to reduce the side effects the preservative may cause. You’ll also likely be given IV fluids (hydration) before and after your transplant to help rid your body of the preservative.

Side effects of the preservative may include:

Not everyone experiences side effects from the preservative, and for some people those side effects are minimal.

After your bone marrow transplant:

When the new stem cells enter your body, they begin to travel through your body and to your bone marrow. In time, they multiply and begin to make new, healthy blood cells. This is called engraftment. It usually takes several weeks before the number of blood cells in your body starts to return to normal. In some people, it may take longer. In the days and weeks after your bone marrow transplant, you’ll have blood tests and other tests to monitor your condition. You may need medicine to manage complications, such as nausea and diarrhea. After your bone marrow transplant, you’ll remain under close medical care. If you’re experiencing infections or other complications, you may need to stay in the hospital for several days or sometimes longer. Depending on the type of transplant and the risk of complications, you’ll need to remain near the hospital for several weeks to months to allow close monitoring. You may also need periodic transfusions of red blood cells and platelets until your bone marrow begins producing enough of those cells on its own. You may be at greater risk of infections or other complications for months to years after your transplant.

Results:

A bone marrow transplant can cure some diseases and put others into remission. Goals of a bone marrow transplant depend on your individual situation, but usually include controlling or curing your disease, extending your life, and improving your quality of life. Some people complete bone marrow transplantation with few side effects and complications. Others experience numerous challenging problems, both short and long term. The severity of side effects and the success of the transplant vary from person to person and sometimes can be difficult to predict before the transplant. It can be discouraging if significant challenges arise during the transplant process. However, it is sometimes helpful to remember that there are many survivors who also experienced some very difficult days during the transplant process but ultimately had successful transplants and have returned to normal activities with a good quality of life.