People who have undergone a stem cell transplant need to be examined regularly by their physicians. The treatment team will closely monitor allogeneic transplant patients for signs of graft-versus-host disease (GVHD), and will monitor patients who have received either allogeneic or autologous transplants for immune system recovery, late complications arising from the high-dose chemotherapy and radiation therapy given prior to transplantation, and any recurrence of cancer.
Our Stem Cell Transplant Survivorship Program
At Memorial Sloan-Kettering, we are dedicated to helping people who have undergone stem cell transplantation live their lives to the fullest after treatment. We offer comprehensive follow-up care for people who have been treated here as part of our institution-wide Survivorship Initiative.
Your follow-up care is provided by a nurse practitioner who specializes in the care of transplantation survivors. In addition to monitoring for signs of cancer recurrence, she focuses on identifying, preventing, and controlling any long-term and late effects associated with transplantation.
An initial education visit addressing your current and anticipated health needs is offered at three months after the time of your transplant. Subsequent follow-up visits with the nurse practitioner include the following:
- Review of your recent medical history and a physical examination
- Assessment to detect recurrence of cancer
- Identification and management of the effects of cancer and its treatment
- Screening referrals for other cancers
- Health promotion recommendations related to nutrition, exercise, and smoking cessation
- Treatment summary and follow-up care plan
- Consultation with your Memorial Sloan-Kettering physician as needed
In addition to working closely with your treatment team, the nurse practitioner provides a treatment summary and survivorship care plan to you, your primary care doctor, and other specialized medical providers. Your physicians can then incorporate this information into your overall medical plan.
Your Follow-Up Care Provider
My name is Christine Iovino, and I am a nurse practitioner with special training in caring for patients who have undergone blood and marrow stem cell transplantation. I graduated from Columbia University’s nurse practitioner program and have worked at Memorial Sloan-Kettering since 1998.
You may experience a range of physical symptoms while recovering from a bone marrow or stem cell transplant. These can include fatigue and weakness, distorted taste sensations, lingering nausea and diarrhea, hair loss or other changes in appearance, and loss of muscle tone. Because your immune system may not recover fully for some time, you will be at risk for infections and colds.
In some patients, cancer may recur following transplantation if the high-dose chemotherapy and radiation given before the transplant did not eliminate all the malignant cells, or if the autologous stem cells harvested before the cytotoxic therapy contained some cancer cells. In an allogeneic transplant, the graft-versus-leukemia process may not always protect a patient from relapse, especially if he or she had relapsed or advanced disease at the time of transplantation.
When a patient's cancer recurs, physicians may shift their treatment strategy to a next-line therapy. In rare instances, patients may develop a secondary cancer or condition such as a myelodysplastic syndrome as a result of the high-dose treatment.
Emotional & Social Challenges
The period after a bone marrow or stem cell transplant can be a difficult and stressful time. To avoid infections, you need to stay away from crowds and from people who are sick. You may feel somewhat isolated, and your treatment-related concerns may affect your social and sexual relationships. Some people find it hard to get back to work, and may not be fully aware of their employment and insurance rights.
Our social workers counsel patients on how to cope with the stresses of illness and how to communicate with family members and children about any concerns. During hospitalization, our inpatient bone marrow transplant social worker provides counseling for individuals, families, and couples, and facilitates a weekly support group for caregivers.
During outpatient visits, a bone marrow transplant social worker can meet with you or your family members, or with everyone together in a family meeting. The outpatient social worker is also available to patients who have been discharged.
In addition, our Counseling Center offers individual and family counseling sessions to help transplant survivors and their families address the problems they may encounter in adjusting to life after treatment.
Living Beyond Cancer
People facing the challenges of cancer survivorship can access a variety of support services through the Survivorship Center section of our website. This includes recommendations about cancer screening, healthy living, counseling, and specialized services to address sexual health. We also offer a range of resources to help survivors, families, and friends better understand the complex emotional and social issues following treatment.
Additional services are offered through our Resources for Life After Cancer program, which provides a full range of educational support services, including individual and family counseling, periodic lectures or workshops to provide medical updates, and practical guidance on employment and insurance issues.
Integrative Medicine Service
Our Integrative Medicine Service is designed to enhance quality of life through healing regimens that address the body, mind, and spirit. Beneficial complementary therapies include various types of massage, acupuncture, hypnotherapy, meditation, visualization and other mind-body therapies, music therapy, and nutritional counseling, as well as classes such as yoga, t'ai chi, and chair aerobics.