Radiation is a very effective treatment for many cancers and blood diseases. Not everyone receives radiation therapy, but, if radiation is part of your treatment plan, you will meet the radiation therapy team either before or after your transplant admission. Prior to beginning radiation you will undergo simulation, which consists of several special X-rays and body measurements. These are needed in some cases to make lead shields which are worn to protect radiation-sensitive organs, such as the lungs, during radiation. Your lungs are especially sensitive to radiation so they need fewer treatments. The radiation technologist will use ink markings on your skin to mark the parts of your body that will be irradiated. In some cases, radiation therapy is given as an outpatient before being admitted for transplantation. These treatments are delivered to areas of residual disease and are given everyday for several weeks.When radiation is administered as an inpatient, fractionated high dose treatments are given to either your entire body, known as Total Body Irradiation (TBI), or to part of your body. They are "fractioned" because they are given two or three times daily over several days. Each treatment may take from 10 to 30 minutes. Based upon the type and stage of your disease, you may require additional radiation to other parts of your body, which will be determined by your physician.
Having a radiation treatment is similar to having an X-ray. You will not see, hear, or feel the radiation. You may, however, experience some nausea following the radiation treatments. It is important that you do not wear any jewelry during radiation therapy because metal may increase the radiation dose to that area. You should also avoid wearing tight clothing and removing the ink marks from your skin until you have fully completed your course of radiation. Do not apply any lotions, creams, or oils to your skin while receiving radiation. You and your clothes do not become radioactive nor do you transmit radiation to other people.
If radiation treatments are a part of your transplant hospitalization, you may be transported for these treatments wearing a mask (for peripheral stem cell recipients) and gown, hat, and gloves (for bone marrow recipients).
Chemotherapy
High-does chemotherapy serves many roiles dueing the transplant. this is the treatment that rids the body of cancers or of the blood disease. the high-does chemotherapy may also weaken the immune system to allow the new marrow graft from the donor to be accepted. Depending on the disease being treated one or more types of chemotherapy (with or without radiation) many be adminisitered as part of the traswnplant. The transplant doctors and clinical nurses will discuss with you which chemothereapy drugs are best for your disease, and they will review the most common side-effects. Some of the more commonly used chemo therapy medications are listed below:
Drug: BCNU (Carmustine)
Given: By Vein
Side Effects:
- Nausea and vomiting one to six hours after treatment
- Burning or pain along the vein may occur while the drug is infusing
- Facial flushing and anxiety may occur during administration of high doses
- Medication will be given to decrease these side effects
- A temporary decrease in blood cell counts (white blood cell, red blood cells, platelets) can occur four to six weeks after treatment and last one to three weeks
- The formation of scar tissue in the lungs may occur with multiple doses of BCNU. Studies may be done to test your lung function.
- A temporary darkening of the skin may occur
Special Points:
- Take anti-nausea medication as instructed
- Protect your skin from overexposure to the sun. Wear protective clothing or SPF 15 sunscreen
Call Your Doctor If You:
- Have a fever
- Have excessive or persistent nausea or vomiting
- Develop any shortness of breath or cough
- Have any unexpected or unexplained problems
- Have any questions or concerns
Drug: Cisplatin (Platinol)
Given: By Vein
Side Effects:
- Nausea, vomiting, or diarrhea may occur one to 96 hours after treatment
- Allergic reactions including rash, hives, or tightness in your chest may occur
- A temporary decrease in blood cell counts (white blood cells, red blood cells, platelets) may occur two to three weeks after treatment
- Changes in kidney function. Tests of your blood and/or urine may be done to check kidney function
- Damage to your hearing may occur
- Temporary hair thinning or loss
Special Points:
- Take anti-nausea medication as instructed
- Drink extra fluids before and after each treatment
Call Your Doctor If You:
- Have a fever
- Have any excessive nausea, vomiting, or diarrhea
- Have any difficulty urinating or blood in your urine
- Have any loss of hearing or ringing in your ears
- Have any unexpected or unexplained problems
- Have any questions or concerns
Drug: Carboplatin (Paraplatin)
Given: By Vein
Side Effects:
- Nausea and vomiting may occur
- A temporary decrease in blood cell counts (white blood cells, red blood cells, platelets) can occur one to two weeks after treatment
- Temporary hair thinning or hair loss may occur
- Damage to your kidneys can occur. Tests of your kidney function may be done
Special Points:
- Take anti-nausea medication as instructed
- Drink extra fluids before and after receiving treatment.
Call Your Doctor If You:
- Have excessive nausea or vomiting
- Have any difficulty urinating
- Have a fever
- Have unexplained or unexpected problems
- Have any questions or concerns
Drug: Thiotepa (Thioplex)
Given: By Vein
Side Effects:
- Nausea and vomiting may occur
- Pain or discomfort along the vein may occur while drug is being given
- A temporary decrease in blood cell counts (white blood cells, red blood cells, platelets) may occur seven to 10 days after treatment
- Some hair thinning or hair loss may occur
Special Points:
- Take your anti-nausea medication as instructed
Call Your Doctor If You:
- Have excessive nausea or vomiting
- Have a fever
- Have any unexplained or unexpected problems
- Have any questions or concerns
Drug: Busulfan (Myleran)
Given: By Mouth as Pills
Side Effects:
- Nausea, vomiting, or loss of appetite
- A temporary decrease in blood cell counts (white blood cells, red blood cells, platelets) may occur 10 to 14 days after each treatment
- The formation of scar tissue in the lungs may occur with multiple doses of Busulfan. Tests may be done to assess your lung function
- Seizures may occur with high doses of Busulfan. Anti-seizure medication may be prescribed
- A temporary darkening of the skin or rash may occur
Special Points:
- Take anti-nausea medication as instructed
- Take Busulfan as instructed. If you miss a dose do not double the next dose. Follow written instructions given to you and alert your nurse or doctor
- Take Busulfan after meals
Call Your Doctor If You:
- Have a fever
- Are not able to take Busulfan due to nausea or vomiting after taking the medication
- Develop mouth sores
- Develop any shortness of breath or cough
- Have unexpected or unexplained problems
- Have any questions or concerns
Drug: ARA-C (Cytarabine)
Given: By Vein or Under the Skin
Side Effects:
- Nausea, vomiting, and a decrease in appetite
- Slight increase in temperature may occur for 24 hours after ARA-C
- Conjunctivitis
- A temporary decrease in blood cell counts (white blood cells, red blood cells, and platelets) may occur after treatment
- Mouth sores
- Temporary hair loss or hair thinning may occur
Special Points:
- Take anti-nausea medication as prescribed
Please Call Your Doctor If You:
- Have a fever
- Have persistent nausea or vomiting
- Develop mouth sores
- Have any questions or if any other problems occur
Drug: VP-16 (Etoposide)
Given: By Vein or By Mouth
Side Effects:
- A decrease in blood pressure may occur while receiving VP-16
- Nausea, vomiting, and diarrhea
- Headache and fever
- Allergic reactions
- A temporary decrease in blood cell counts (white blood cells, red blood cells, and platelets) may occur after treatment
- Mouth sores
- Temporary hair loss or hair thinning may occur after treatment
Special Points:
- Take anti-nausea medication as prescribed
- Rinse mouth after meals and before bed with baking soda and water to reduce mouth sores
Call Your Doctor If You:
- Have a fever
- Have any muscle or joint pain
- Have persistent nausea or vomiting
- Have any questions or if any other problems occur
Drug: Cytoxan (Cyclophosphamide)
Given: By Vein or By Mouth
Side Effects:
- Nausea and vomiting
- Temporary nasal congestion
- Damage to bladder may occur. Blood and urine tests will be done to monitor kidney function. Measures will be taken to prevent problems - Some distortion to taste and smell
- Temporary hair loss or thinning may occur
- Temporary cessation of menstruation may occur
- A temporary decrease in blood cell counts (white blood cells, red blood cells, and platelets) may occur after treatment
Special Points:
- Take anti-nausea medication as prescribed
- Drink at least eight glasses of any fluid for three days following treatment to flush the bladder
Call Your Doctor If You:
- Have a fever
- Have persistent nausea or vomiting
- Have bloody urine
- Have any questions or if any other problems occurDrug: Methotrexate (Folex)
Given: By Vein Side Effects:
- Nausea, vomiting, or diarrhea
- Headache with intrathecal use
- A temporary decrease in blood cell counts (white blood cells, red blood cells, platelets) may occur seven to 10 days after treatment
- Mouth sores
- Changes in kidney, liver, and/or lung function may occur
- Temporary hair thinning or loss
Other:
With high doses of Methotrexate your doctor may prescribe a drug called Leucovorin. This drug helps to protect your normal cells from damage and decreases the severity of Methotrexate side effects.
Special Points:
- Take anti-nausea medication as instructed
- Take Leucovorin (when prescribed) as instructed
- Avoid long periods in sunlight and wear protective clothing or sunscreen with SPF of 15 or higher
Call Your Doctor If You:
- Have a fever
- Develop mouth sores
- Develop any shortness of breath or cough
- Have any difficulty urinating or abdominal pain
- Have any unexplained or unexpected problems
- Have any questions or concerns
Drug: Tamoxifen
Given: OrallyDescription: Blocks the cancer cells ability to grow using the hormone, Estrogen
Side Effects:
- Hot flashes
- Mild nausea and vomiting 12 to 24 hours after taking medication
- A skin rash may occur 24 to 48 hours after taking medication
- A temporary increase in bone or tumor pain may occur during the first month of treatment
- Vaginal dryness may occur
- A temporary swelling or puffiness of hands and feet may occur
- Cessation of menstrual period may occur, but contraceptives should be discussed with patient
Special Points:
- Vaginal dryness can be relieved by using a water soluble lubricant such as Lubrin, Replens, or K-Y jelly
Call Your Doctor If You:
- Have blurred or changed vision
- Have any unexpected problems
Drug: Arimidex
Given: OrallyDescription: Blocks the cancer cells ability to grow using the hormone, Estrogen
Side Effects:
- Hot flashes
- Mild nausea and vomiting 12 to 24 hours after taking medication
- A skin rash may occur 24 to 48 hours after taking medication
- A temporary increase in bone or tumor pain may occur during the first month of treatment
- Vaginal dryness may occur
- A temporary swelling or puffiness of hands and feet may occur
- Cessation of menstrual period may occur, but contraceptives should be discussed with patient
Special Points:
- Vaginal dryness can be relieved by using a water soluble lubricant such as Lubrin, Replens, or K-Y jelly
Call Your Doctor If You:
- Have blurred or changed vision
- Have any unexpected problems
Drug: Interleukin-2 (IL-2)
Given: By Vein
Description: Promotes your body's immune response to help fight cancer
Side Effects:
- Flu like symptoms including fever, chills, fatigue, headache, and painful joints
- Redness of skin, rash, or itching
- Redness or discomfort at I.V. site
- A temporary decrease in urination, difficulty urinating, or fluid retention
- A temporary decrease in blood cell counts (red blood cells, white blood cells, platelets) may occur
- Changes in heart, liver, and/or lung function may occur. Tests may be done to evaluate these functions
- Changes in mental status may occur
Special Points:
- Treatment with IL-2 may be stopped at any time depending upon the severity of side effects
- IL-2 is an extremely toxic drug that requires close monitoring of your condition by your nurse and doctor
Call Your Doctor If You:
- Have a fever
- Have any difficulty urinating or retention of fluid
- Have any unexplained or unexpected problems
- Have any questions or concerns
Drug: Interferon
Description: Promotes your body's immune response to help fight cancer
Given: By Vein or Under the Skin
Solution:
Clear
Side Effects:
- Flu-like symptoms include fever, chills, fatigue, muscle pain, and headache within two hours of treatment. Take Tylenol before treatment and every four hours to prevent fever and chills. Report to doctor if temperature persists or chills worsen
- Nausea, vomiting, and anorexia (loss of appetite)
a. Report nausea and/or vomiting to nurse or doctor
b. Medicine can be prescribed
c. Report significant weight loss to nurse or doctor
d. Eat small frequent meals
e. Nutritional supplements are available
- Bone Marrow Depression (lowered blood count)
a. Report any signs/symptoms of infection to the nurse or doctor.
Conditions to be reported include:
a common cold, a fever, pain or burning with urination, foul smelling urine, frequency of urination, redness, pain or swelling of any area of the body, ulceration or abscess formation.
b. Limit activities that may lead to falls, cuts and bruises
c. Report any signs of bruising or bleeding to nurse or doctor
Drug: Gamimune (Immune Globulin Intravenous)
Description: Promotes your body's immune response to help fight cancer
Given:By Vein
Solution: Clear
Side Effects:
Allergic reactions
- Inform doctor or nurse if you have ever experienced an allergic reaction to an immunoglobulin injection (intramuscular or intravenous), if known
- Report these symptoms to nurse immediately; wheezing or difficulty breathing, headache, dizziness, anxiety, rashes, nausea, vomiting, back or hip pain, fever, chills
