Q. After two recurrences of lymphoma, my oncologist is suggesting I have a bone marrow transplant. Is there financial assistance available for transplants? And I don't have any siblings so how can I find a match?
In 1956, E. Donnall Thomas performed the first successful syngeneic (genetically identical) bone marrow transplant and in 1990, he became co-recipient of the Nobel Prize for Physiology or Medicine for his pioneering work. Today, thousands of bone marrow transplants are performed at over a hundred medical centers around the U.S. While they have been tried on some solid tumor cancers, they are primarily done for blood cancers and blood disorders where they have proven to be most successful.
There are several types of bone marrow transplants: allogeneic (donor cells, “allo” means other), autologous (patient cells, “auto” means self) and umbilical cord blood transplant (umbilical cord blood saved right after birth). They are called bone marrow transplants (BMT, harvested from the bone marrow), or stem cell transplants (SCT, taken by aphaeresis).
Because many types of blood cancers are hard to cure with current treatments, transplants are used to make it possible for patients to receive very high doses of chemotherapy and/or radiation to kill the disease, and then reinfused with their own or a donors cells to rebuild their immune system and help them recover.
While transplants have become more frequent within the last decade, with improved prognosis and better recovery, they are still costly and require advance preparation for your time in the hospital and during your recovery afterward. Many insurance carriers, as well as Medicare and Medicaid, cover most transplant costs. Your transplant team will work closely with you to help prepare for these needs, as well as search for a donor through a national registry, if you don’t have a family match.
For more information, read The National Cancer Institute’s fact sheet, Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation. You may also contact The National Marrow Donor Program (NMDP) to learn more about their Be The Match Program and about the donor selection and transplant process.
Q. I finished my chemotherapy for anaplastic stage IV lymphoma over a year ago, but I still must nap every day. Will there come a day when I will not be so exhausted?
Fatigue is one of the most common side effects of cancer treatment and ranks at the top of symptoms reported along side of pain. More often medical experts focus on treating pain rather than fatigue because of the degree of discomfort for the patient. However, over the long term, fatigue can have an equally profound effect on quality of life for many patients. Simple activities of daily living can take longer, require more energy, and be debilitating. The end result is that people may retreat from many of the activities that brought them happiness prior to cancer treatment.
Fatigue is an expected side effect of chemotherapy and radiation and usually dissipates over time after treatment has ended. But in some cases, it can go on for years or become a chronic condition. There are three factors one needs to look at when addressing fatigue: physical, psychological, and emotional. Sometimes only one factor may be the cause of fatigue; other times it might be a combination. Interventions to combat fatigue can be pharmacological, behavioral or psychological. Integrative medicine practices (e.g., acupuncture, meditation and vitamin supplements) can also be utilized. Fatigue during treatment, or lingering well past, should be discussed with your oncology team and be explored with other medical specialists as needed. In some instances, the underlying cause of chronic fatigue might not be identified, but with help, people can find ways to adapt and still enjoy a full life.
To learn more about coping with fatigue, please watch Memorial Sloan Kettering’s informative webcast, Coping With Fatigue After Cancer Treatment and read CancerCare’s fact sheet, Fatigue is a Medical Condition.
Q. I am 67 years old and have had non-Hodgkin's lymphoma for 7 years. I have decided not to receive further treatment. What will happen as I progress? Will I have pain?
You have made a difficult decision to change the focus of your treatment from curative to palliative. No doubt this decision was made after careful consideration and consultation with your doctors and members of your support team.
Most people report that they are not as fearful about dying as they are about the possibility of experiencing pain and distress. There are many ways to address physical pain and you can learn specific ways to describe your pain to your treatment team in our booklet, Controlling Cancer Pain: What You Need to Know to Get Relief.
Palliative care may be available through your local treatment center, or may be accessed through hospice. Palliative care and hospice services are provided by medical professionals who have an expertise in managing symptoms, social workers who provide support you and your family, and chaplains who provide spiritual care. Getting to know your team of health care professionals early after you decide to pursue palliative treatment will allow them to get to know you and your preferences, as well as how you respond to pain management techniques. The National Hospice and Palliative Care Organization’s Caring Connections website offers information about living with a serious illness and pain management. We offer a fact sheet, Your Health Care Team: Your Doctor is Only the Beginning, that outlines professionals who may be available to help you.
Hospice care recognizes that for some people with cancer, a cure is not possible. The focus of hospice services is to create the best quality of life for a patient by treating his or her physical, emotional, and spiritual needs, as well as supporting family needs.
While your care at this time is palliative in nature, the importance of hope can not be dismissed. Hope is that balance between positive attitude and expectations for the future. Hope can continue to nourish you, and you can nurture hope through the way in which you continue to live your life. Settling old problems and practical affairs will give you peace of mind. Make plans with family and friends as you are able to continue to engage in the activities that you enjoy. Focusing on the purpose and goals of each day will set up an achievable plan and completing what you can each day will give you satisfaction that you have done your best.
Q. My 90-year-old grandmother was just diagnosed with lymphoma, but was told that because it is at an advanced stage, no treatment will be done. What should we expect?
Lymphoma is the term used to describe cancer of white blood cells, called lymphocytes, which are a crucial component of the immune system. As with any cancer, there are important factors in determining a patient’s prognosis. These include the type of cancer, the stage of the cancer, the age of the patient and the patient’s general health. It is also important to consider whether the cancer is a new diagnosis or whether it has recurred.
While it is not possible to tell you exactly what to expect, it is important to begin to plan for her care. Talk with her doctor and find out more details. For guidance, please read our publications, Communicating With Your Health Care Team and Doctor, Can We Talk?.
It will be helpful to develop a plan that includes all available family, social, and medical supports to care for your grandmother in body, mind, and spirit. You may also want to discuss with your grandmother what her wishes are regarding her care. It is important to have information about your grandmother’s health insurance or other coverage she may have and what medical and supportive care services they can provide during this time. Hospice should be considered and can provide support and services if your grandmother’s needs increase.
The Leukemia & Lymphoma Society provides specific information about lymphoma and offers support services provided through their local chapters.