What tests are required to be able to have a stem cell transplant?
So we'll do heart function test prior to transplant to make sure their heart function functions good. We'll do lung function tests where they breathe in tubes called PFTs or pulmonary function tests. We'll do the 24-hour urine to know what their baseline, how much protein they have, how much myeloma protein, and what their creatinine clearances to know how good their kidney function is, to know if we should reduce the dose of the melphalan. We'll do a bone marrow biopsy in our program to know exactly how much myeloma they have going into the transplant. And if they're still packed with myeloma, then we probably would want to give them some more effective therapy before proceeding. We typically do some imaging to know how extensive are their lesions, and it sort of depends on what they had at baseline. If they had active disease on a PET scan, for example, we may repeat that prior to transplant to know how much response they've had. So bloodwork, bone marrow, heart, lung function, urine, extensive array of tests prior to that stem cell transplant to really vigorously check to make sure they're going to be a candidate and to know exactly how much disease they have going into it.
Why is screening (testing) needed prior to transplant?
A few different reasons. We want to have good heart and lung function. First of all, these patients going through transplant have a lot of GI symptoms. They may end up getting a lot of IV fluids. They may have infections or bloodstream infections that require a lot of IV fluids. And for their system to be able to handle the stress of going through all of that and the blood pressure going up and down and the potentially life-threatening infections, we want to have good heart function and good lung function so that we don't flood their lungs with fluids and tip them over and cause them to end up on a ventilator. And also, if they were to develop pneumonia, are they going to be able to withstand that side effect? And if they have really, really low lung reserves, then getting a pneumonia is going to be very likely fatal. And so it's not as bad as some of the other stem cell transplant regimens, like for example, for lymphoma, where they use more lung toxic regimens. Melphalan is not necessarily highly toxic for heart or lungs, but it's really to be able to withstand the whole process. First of all, we do all the restaging for the myeloma because the transplant is supposed to be the last deconsolidation. So, with the therapy you achieve a response. But then the chemotherapy is supposed to bring you down even deeper. And so we do testing to make sure that the patient is eligible for transplant. So we check the myeloma. We like to do the transplant. If a patient has achieved at least a very good partial response. So at least a 90% reduction, because remember, we collect the patients themselves. So if we have a lot of myeloma, if we have a lot of marrow involvement, we are not going to be able to collect a good product and then for safety. And now the chemotherapy in the melphalan is no organ damage chemotherapy. So it will be a case report for a patient developing cardiac toxicity, lung damage, liver. It can happen because patients have pre-condition. So we do and they receive chemotherapy before. So we do all the testing, the echocardiogram, we assess the cardiac function, the pulmonary function test, X-rays, all the virology to make sure they don't have an ongoing infection as all this testing is called a pretransplant preparation. And if we found that a patient having some cardiac issues, we refer the patient to the cardiology for clearance because the transplant is safe, at Duke, it’s an outpatient procedure. The mortality is really close to zero. I always say 1 to 2%. But if you send a patient to transplant with a lot of medical issues, that is a different story. So all these to start down for safety so I can give them the chemotherapy and then they have a couple of weeks of recovery and that it could be a stressful situation. So some patients with if they have lung compromisations because prior smoking or COPD and then to develop an infection is not an easy complication. But that said, the test is called a pretransplant preparation. We go through all the tests and then if we need referring patients, we will do the cardiology, pulmonology, infectious disease, and then we prepare a package for the insurance and we get the approval. They look all the tests for safety and we got the approval after that.
HealthTree • February 21, 2025
