There’s no way to know for sure whether a successfully treated cancer will come back. But circulating tumor DNA, or ctDNA, testing can help. If you or a loved one has recently completed treatment, here are five important points you should know about this new technology.

1. ctDNA tests look for minimal residual disease.

Even after a patient finishes treatment for cancer, some cancer cells can still be left behind, circulating in the patient’s blood. These tiny bits are called minimal residual disease, or MRD.

ctDNA tests work by looking for MRD in a patient’s blood. “All cancers have a special genetic makeup—they have mutations that can be picked up in the bloodstream,” said Namrata Vijayvergia, MD, a hematologist/oncologist at Fox Chase Cancer Center.

The test first gathers genetic material from a tumor itself (either before or during treatment). After treatment, that same genetic material is tested for MRD in a patient’s blood. If the bloodwork tests positive, the patient has some amount of MRD circulating in the body and is at risk for recurrence.

2. ctDNA tests can catch cancers earlier than standard screening methods.

Standard imaging tests like CT, MRI, and PET scans can find tumors that have already formed, showing that a patient’s cancer has come back. But ctDNA tests are much more sensitive.

“A ctDNA analysis can find even tiny amounts of genetic material released from existing cancer cells,” Vijayvergia explained. “So the threshold for detection is much lower.” That means possible recurrences can be caught sooner, before they even cause symptoms.

3. The tests aren’t for every patient.

ctDNA tests are relatively new, so they’re not yet widely used for many cancers. “The tests are the most advanced in detecting colorectal cancer,” Vijayvergia said. In some cases, ctDNA testing is also employed to detect recurrences in breast, non-small cell lung, and muscle-invasive bladder cancers.

“Typically what we do now is, after surgery, we see patients every three to six months and do bloodwork,” Vijayvergia said. “If we’re monitoring for recurrence, we’ll include a ctDNA test.”

4. Finding MRD means a patient is at high risk for recurrence.

A patient’s cancer hasn’t actually recurred if MRD is detected in their bloodstream. “However, having a positive ctDNA is a sign that there’s a more than 95% chance that the cancer will recur at some point,” Vijayvergia explained. In other words, the seeds have been sown—but nothing has actually grown yet.

5. A positive ctDNA test isn’t a reason to restart treatment—for now.

Finding MRD means a patient’s cancer is very likely to come back in the future. But currently, there’s no way to know when the cancer might come back—or if anything can be done to stop it.

“In the future, it could mean patients with ctDNA left behind should intensify their therapy,” Vijayvergia said. “These are things we’re studying.”

Today, a positive test result can help patients and their doctors decide if they need closer monitoring for a possible recurrence. “For colorectal cancer patients, we might decide to repeat a CT scan, or a PET scan, or check to see if they’ve had a recent colonoscopy. If those are OK, we continue to watch them,” Vijayvergia said.

If you have questions about ctDNA and whether it can be used as a part of your follow-up care after cancer treatment, it’s best to discuss with your oncologist.

Finding out you have cancer is hard, but telling the ones you love can be even harder. 

The truth is, there’s no instruction manual for sharing difficult news like a cancer diagnosis.  But there are some strategies that can make the conversation easier. 

First, take some time to decide who you’d like to share the news with—and how much detail you want to include.  The answer doesn’t have to be one-size-fits-all. It may help to think of your social connections as concentric circles and choose a different approach for each. For example, you might share everything with your close friends and family but keep things vague with co-workers or acquaintances.  

The advice below can help you choose your approach to each group—and decide what to say when you don’t want to talk about your diagnosis. 

Sharing with your inner circle 

Conversations with your partner, children, or other close family members and friends call for plenty of time and privacy. 

There’s no right or wrong way to break the news, but it may help to: 

• Tell them in advance that what you need to talk about is very important. 
• Taking some time to think about what you want to say, 
• Anticipate the questions your loved ones might ask and how you’ll respond. 

Your loved one will likely be shocked by the news. And their reaction might be unexpected. Everyone responds to bad news in their own way. Some offer support right away, while others need some time to process. 

Even if you’re worried about making your loved one upset or scared, resist the urge to put on a happy face for the sake of protecting them. It’s normal and OK to be emotional. And being honest about how you feel is better for everyone. 

Sharing your emotions—and asking your loved ones about theirs—can let you work through them together. But remember, it’s also OK to say you aren’t ready to talk about something yet. You don’t have to cover everything in one conversation. 

You don’t need to share all the news alone either. If describing the details of your diagnosis or treatment plan feels overwhelming, you can ask your care team to help explain any complex or technical details. If you worry that a loved one might become more upset than you and you won’t be able to comfort them, a social worker or counselor can serve as a mediator as well. 

Sharing with everyone else 

When you share with your wider circle, you might choose to communicate with several people at once. You could do that in person, via email or text, or through a “spokesperson”—a friend or family member you ask to act as press secretary and dispense information to a list of extended family, friends, and others in your community.  

You might also use a website or social media channel to share updates with a wider group. Pay close attention to any privacy settings—and remember that information may spread further than you’d planned. 

Before you let your larger circle know about your diagnosis, decide how much you want to share—and what topics are off-limits. Come up with a response to unwanted questions ahead of time. You might say something as simple as “Thanks for asking, but I’d rather not talk about it right now.” 

On the other hand, if you do feel an urge to talk, go ahead. For many people, sharing the news makes it real—and helps them process and accept it. It also gives your community the opportunity to support you.  

If you need additional tips for talking about your diagnosis to others, don’t be afraid to reach out to your care team for support. At Fox Chase, your team is here to offer support at every step of your journey. And our social workers and psychologists specialize in helping people with cancer—and their loved ones—cope with their condition. Call 888-369-2427 or request an appointment online. 

Finding out that a friend or loved one has cancer can be shocking, intensely upsetting, and even uncomfortable. Knowing the right thing to say or do isn’t always easy, even when you’re very close to that person.

The good news is that showing your support might be more straightforward than you think. Here are five things you can consider if you are told this news:

1. First and foremost, listen: A compassionate set of ears is one of the best things you can offer. Opening up about their diagnosis helps patients make sense of their emotions and come to terms with their cancer.

“Understand that this person needs to tell their story,” said Paula H. Finestone, PhD, a clinical psychologist at Fox Chase Cancer Center.

Allowing your friend or loved one to fully share what they’re going through and how they’re feeling is incredibly important. Let them know you’re listening by giving them your full attention and maintaining good eye contact. When they stop talking, resist the urge to jump in with your own thoughts right away—they might be taking a pause but have more to say.

2. Say something supportive: When it’s your turn to say something, speak from the heart, but keep it simple. You can show that you care by saying things like “I’m sorry this is happening to you,” or “This must be really hard for you.” Let them know that you’re there for them anytime they need to talk.

You should not try to solve their problems or tell them you know how they feel (unless you’ve had the same cancer). And above all, don’t tell sad stories.

“Avoid sharing things about someone else who went through a similar cancer journey without a positive outcome,” Finestone said.

3. Offer realistic optimism: It’s good to be hopeful, but it’s not good to downplay the facts of the person’s diagnosis. Don’t say everything is going to be fine, that the person is definitely going to beat their disease, or that they’re lucky to have a “good” type of cancer.

Instead, just focus on the good that’s happening at that time.

“If the person is having a good day, focus on that,’” Finestone said.

4. Ask how you can help: Chances are, your friend or loved one is drained—both physically and emotionally. To support them, you can ask what you can do to make their life a little easier. If they don’t have an answer, offer a few specific suggestions of your own.

“You can ask if it would help if you brought them a meal once a week or run errands for them,” Finestone said.

5. Stay in touch: Keep checking in with your loved one on a regular basis. This will help keep your relationship balanced and provide some sense of normalcy for them, which is something the person will likely appreciate.

If they’re not up for talking, let them know that’s okay! Sometimes, a friendly text or voicemail can provide the support they need. Facing cancer can be exhausting, and you can always check back with them later or leave the ball in their court.

There are many ways we can support our loved ones when they receive a cancer diagnosis. The most important thing is letting them know that you care about them and will be there for them throughout their journey.

One minute, life is going along as usual, and then boom—you find out you have cancer. At that point, everything changes in an instant, and you know right away that life will never be the same.

Coming to terms with this new reality is a multistep process that takes time. A clinical psychologist at Fox Chase Cancer Center, explains the common emotional stages patients go through:

Shock: Is this really happening to me?

Hearing your diagnosis can feel like a bad dream.

“Intellectually, we know that cancer happens,” they said. “But we don’t think it’s going to happen to us.”

This early sense of disbelief can be different for each individual and can range from denial to simply pretending nothing is wrong.

Learning everything you can about your specific diagnosis can help. It’s recommended that you talk with your care team, research your cancer using reputable sources, and talk to others who’ve gone through a similar experience. Gathering information helps put you in control, which can make the situation feel more real and manageable.

Fear: Am I going to survive?

When we think of cancer, we tend to think of the worst.

This fear might be intensified if you’ve watched loved ones go through the same thing. To combat this, it’s important to understand that every person and every cancer is different. Thanks to new treatments and technologies, the chances of a positive outcome are better than ever before.

Guilt: What did I do wrong?

“Whenever crisis hits us, we want to know where it came from and why it’s happening to us,” said the clinical psychologist.

You might blame yourself for certain choices you made in the past that may or may not be related to your diagnosis. The truth is, no one knows why some people get cancer, and beating yourself up over the past won’t change what happens today or tomorrow. Instead, try focusing on what’s happening right now.

“If you feel good in that exact moment, enjoy that,” they recommended. “If you’re having a bad day or not feeling well, that’s a call to action to talk with your care team about additional support.”

Loss: Who am I now?

You might feel like your sense of self is being swallowed up by your cancer. It can take over your thoughts and your schedule as well as change the way you see yourself.

“It’s not just mourning your old way of life,” they said. “People feel a sense of loss over their appearance, too. This can come from losing their hair, losing weight, or looking very pale.”

When you start dwelling on what your cancer has taken away, try to think about what this experience might be able to give.

“Maybe it will motivate you to strive for a better work-life balance, speak up for your needs, or reprioritize your relationships,” theysaid.

Acceptance: I have cancer. I’m going to get through this.

“Over time, the routine of coming in for treatment becomes a part of everyday life, and we adjust and adapt,” said the clinical psychologist. “But it won’t happen overnight. It’s a slow and gradual process.”

What matters most is that you continue to move forward and seek help from social workers or psychologists if you need additional support on your journey. Many healthcare institutions offer these services to patients, and it’s always a good idea to speak to your care team about supportive services that can address your emotional needs during this difficult time.

The COVID-19 pandemic has put a bigger focus on germs and illnesses than ever before. But, as a dedicated cancer center, minimizing our patients’ exposure to bacteria, viruses, and other microbes has always been part of our standard operating procedure. And, during the current public health crisis, our environmental services (EVS) team is trialing innovative methods to do more.

“Our number one mission is to make sure our patients are safe,” said Jonathan Wright, Director of EVS at Fox Chase. “We also need to make sure our clinicians and staff are safe so that they can continue to treat patients.”

Advanced Technologies

To do this, our EVS team follows strict procedures and consistently introduces new technologies and cleaning methods to our existing protocols.

“Our cleaning program involves multiple steps that have proven quite successful,” Wright said. “In addition to our standard disinfecting procedures, we employ added layers of protection for the deepest—and longest-lasting—clean.”

These include:

• Dry steam technology: Some cleaning chemicals leave behind a residue that can act as food for viruses, Wright explained. After applying disinfecting chemicals to surfaces at Fox Chase, we get rid of the residue by applying high-concentration steam.
• Electrostatic disinfection: To destroy any lingering microbes, we apply a high-tech disinfecting mist that electrocutes any remaining germs. “If the cleaner missed something, the electrostatic chemicals will take care of that area,” Wright said.
• ATP testing: Along with regular cleaning with various protocols, we regularly measure the number of germs on surfaces to see which areas need to be cleaned more heavily or frequently. “We use that data to give us perspective in terms of how effective our current protocols are,” Wright explained.

The Future of Cleaning

Other advanced cleaning technologies are coming to Fox Chase soon. Wright and his team have been piloting the use of the BIOPROTECTUs™ system, which is designed to keep surfaces free of germs for up to 90 days.

“It’s a game-changer,” he said. “We’ve been using it throughout the hospital in trials and have found our infection rates are even lower than before.”

Traditional wet disinfectants only prevent the growth of germs for a few minutes (until the cleaner dries), but the BIOPROTECTUs™ system works differently.

“It uses an oxidizing cleaner, which doesn’t allow any microbes that require oxygen to grow on surfaces where it’s used,” Wright said. “Then we apply a surface protectant, which seals up pores so dirt and grime can’t penetrate them.”

Fox Chase will also be getting ultraviolet disinfecting units soon. These advanced machines emit artificial UV light that works to deactivate germs and bacteria.

“This cleaning method is effective at killing microbes like Clostridium difficile (C. Diff.), which have a protective wall,” Wright said. “We plan to deploy them in operating rooms, inpatient units, therapy areas, and the infusion room.”

COVID-19 Protocols

While these technologies and the other cleaning products we use are key components in keeping our facilities clean and safe during the COVID-19 pandemic, Fox Chase’s screening procedures, PPE protocols and no-visitor policy also play important roles.

“Our staff is wearing appropriate PPE—masks, gloves, gowns, and more —and we’re washing our hands, changing our gloves, and changing PPE as we move from one room to another so that we’re walking in clean to the next patient,” said Kathy Rich, Housekeeping Supervisor at Fox Chase.

Together, these measures are making a difference in keeping COVID-19 out of our center.

“We’re doing our best to control the environment at Fox Chase, and the infection-control numbers verify we’re doing a great job,” Wright said. “Patients at Fox Chase can feel very safe.”

Learn more about coronavirus precautions at Fox Chase

We know that the COVID-19 vaccinations available for use in the United States are both safe and highly effective. Both the Pfizer BioNTech and Moderna COVID-19 vaccines have been through a stringent clinical trial process approved for emergency use by the U.S. Food and Drug Administration. But, if you or a loved one has—or previously had—cancer, you may still have a lot of questions about the vaccines.

Every cancer patient is different, and the first step to getting vaccinated is talking with your oncologist about your cancer and treatment to determine the right immunization plan for you.

“As the vaccines become available, your particular situation should be discussed with your provider,” explained Jeffrey Farma, MD, FACS, a surgical oncologist at Fox Chase Cancer Center.

That said, there are some things experts can say for sure about the vaccines right now, and that information is important for every cancer patient and survivor to know:

• If you have ever had cancer, you should get the vaccine when it is available to you: Getting vaccinated is the best way to protect yourself against COVID-19, and experts agree that high-risk groups (like cancer patients and others with underlying medical conditions) should be prioritized for immunizations. But again, it’s crucial to talk with your care team to determine the best vaccination plan for you based on your cancer type and treatment plan (especially if you are undergoing active treatment for cancer).
  • For patients undergoing chemotherapy, radiation, or targeted therapy: These treatments may lessen the vaccine’s effectiveness, but experts don’t know by how much yet. “The point of vaccination is to have the immune system create a response to protect against the virus, and the immune system might not create enough of a response if you’re immunocompromised,” Farma said. In most cases the benefits of getting vaccinated are still worth it and will not affect your treatment.
  • For patients on immunotherapy: This form of treatment actually stimulates the immune system instead of suppressing it. Vaccinations for these patients will generally be encouraged.
  • For patients participating in a clinical trial: Clinical trials usually have specific guidelines regarding what is allowed and not allowed for patients participating in the study. “Both of the currently approved COVID-19 vaccinations are mRNA vaccines. They are not live vaccines [which are often not permissible on a clinical trial]. Both are safe and patients may be allowed to receive them while participating in a clinical trial,” said Anthony Olszanski, MD, RPh, a medical oncologist at Fox Chase. “We don’t anticipate that you would have to stop your clinical trial treatment to receive the COVID-19 vaccine.”
  • For patients undergoing surgery: Patients should allow for a certain number of weeks in between their vaccination and surgery. “These are unique situations that should be discussed on a case-by-case basis,” Farma said. For some, it might make more sense to undergo surgery and get vaccinated after they’ve recovered. For others, putting off surgery until after getting the vaccine might make more sense.
  • For patients who have undergone or are undergoing a bone marrow transplant (BMT): The idea behind a BMT is to wipe out the immune system and bring a new one in, a rejuvenated one. “But, there is going to be a time when there simply isn’t adequate bone marrow to generate an immune response. Your hematologist will know best when that window of opportunity is and when the COVID-19 vaccine is most likely to be most effective,” Olszanski said.
  • For survivors or those in active surveillance: Patients in the surveillance phase or those who have been free from cancer for longer than five years should be vaccinated. Talk with your doctor about any specific questions or concerns you might have, like whether you still fall into a high-risk category and should get vaccinated sooner.
• The vaccines have been tested thoroughly enough to know that they’re safe: “The entire clinical trial scenario, while expedited, has not been rushed. It has worked the way it is supposed to work. Tens of thousands of people were and are currently on the trials. Hundreds of thousands of people have been vaccinated to date,” Olszanski said. “These vaccines are considered safe, and everyone should be seeking out a vaccine as soon as it is available to them.”
• The COVID-19 vaccines will not cause you to get the coronavirus: “There is no danger of someone who’s immunocompromised getting COVID-19 from the vaccine,” Farma said.
• You’ll still need to wear your mask and continue social distancing after being vaccinated—for now: It’ll take some time before enough people are vaccinated to achieve herd immunity—where the majority of the population is protected. “When we have the majority of people vaccinated and the number of new cases falls dramatically, we’ll get the go-ahead to start relaxing our guard a little bit,” Olszanski said. “But, we shouldn’t do that until we’re told to. We must continue to be vigilant and do our part until we are told otherwise.”
• Vaccinations for patients are coming soon: The vaccines are currently approved for emergency use and are now being given to health care workers, residents of long-term care facilities, and specific groups who are eligible to receive it according to CDC guidance. But they’re expected to become more widely available soon. “It is our hope that by springtime, more of the general population should be able to get vaccinated,” Farma said. “And cancer patients are one group who’ll be at the top of the list.”

That’s why he recommends starting the vaccination conversation with your care team now. “It’s happening. We are beginning to see a light at the end of a very dark tunnel.” Farma said.

The holiday season is often filled with joy and love, and historically, it is a time shared with family and friends. This year however, as COVID-19 cases continue to rise, we all need to do our part by practicing social distancing. This is especially important for our loved ones who are facing a cancer diagnosis.

In the midst of cancer treatment, many patients and their caregivers feel isolated. These feelings can intensify during the holiday season, and it’s especially common this year due to the COVID-19 pandemic. While you may not be able to be physically close with your loved ones, there are many ways you can check in with them and their caregivers, be a helpful part of their day-to-day routine, and make a difference during this difficult time.

Below are a few ways you can safely reach out and support those facing cancer during the holidays this year:

• Provide Meals – Take the pressure off primary caregivers and organize a meal train with other loved ones. You can provide meals or gift cards to your loved one’s favorite restaurants and drop them at the door or send them by mail. It’s a good idea to ask about special diets or favorite foods and practice proper hygiene and distancing when delivering.
• Add Some Holiday Spirit – Spruce up their surroundings this holiday season by offering to pick up festive decorations, wrap gifts, or pick up presents at a local store. You could even surprise them by decorating the outside of their home with lights or other holiday décor. These small touches can bring so much joy and make a big difference.
• Make Virtual Connections – You could offer to remotely watch a holiday movie together or send an e-card or a personalized video to someone who is in the hospital and can’t receive physical gifts. A standing appointment via phone or video chat can break up the day and give them something to look forward to.
• Involve Family and Friends – Reach out to family and friends and suggest that they send cards or small gifts. Receiving something in the mail unexpectedly can change someone’s day, especially if it is a note from someone they love.
• Share Hobbies – Maybe your loved one loves to read. If so, you could start a book club. Or, if they love music, getting them tickets to a virtual concert would be a great idea. You can identify something you both love and find a way to enjoy it together virtually!

It’s hard being in isolation during a pandemic, and it’s even harder during the holidays. This year more than ever before, it’s important to keep in touch with your loved ones and let them know that you are available. And, don’t be afraid to think outside of the box when it comes to letting them know you care!

Patients with mantle cell lymphoma treated at Fox Chase Cancer Center will now have access to treatment with brexucabtagene autoleucel (also known as TecartusTM), the first cell-based gene therapy approved by the Food and Drug Administration (FDA).

Tecartus, a chimeric antigen receptor (CAR) T-cell therapy, was recently approved for adults with mantle cell lymphoma who have not responded to or who have relapsed following other kinds of treatment, and Fox Chase is a certified treatment center for the therapy.

With CAR T-cell therapy, patients’ T cells are collected and genetically modified to include a new gene that helps target and kill lymphoma cells. These modified T cells are then infused back into the patient.

“This is one of the most promising therapies for patients with mantle cell lymphoma, including those with a type of disease called P53-mutated mantle cell lymphoma,” said Henry Chi Hang Fung, MD, FACP, FRCPE, Chair of the Department of Bone Marrow Transplant and Cellular Therapies at Fox Chase.

Fung was an investigator on the clinical trial that led to the FDA’s approval of Tecartus, which looked at the safety and efficacy of the therapy in patients with relapsed or refractory mantle cell lymphoma. In the trial, 87% of participants responded to a single infusion of the therapy, and all signs of cancer disappeared—a complete response—in 62% of patients.

“A complete response rate of greater than 60% with Tecartus is even better than responses seen with first-line treatment after the initial diagnosis,” Fung said. “It is a very effective treatment.”

Mantle cell lymphoma is an uncommon subtype of non-Hodgkin lymphoma that occurs in cells originating in the mantle zone of the lymph node.

Patients diagnosed with the disease will typically undergo initial treatment with chemotherapy or a stem cell transplant. However, even with transplant, the disease often recurs.

In recent years, several other treatments known as Bruton’s tyrosine kinase (BTK) inhibitors have been approved for patients with mantle cell lymphoma who have received at least one prior type of therapy; however, these medications aren’t always enough.

“When patients failed these treatments in the past, even after having durable responses, we had nothing to offer them,” Fung said. “The responses we are seeing with Tecartus are like nothing we have seen in the history of mantle cell lymphoma.”

Fox Chase also provides FDA-approved CAR T-cell therapy for relapsed or refractory large B-cell lymphoma in adults and refractory B-cell precursor acute lymphoblastic leukemia in young adults up to 25 years old.

The effectiveness of cellular immunotherapy against other blood cancers is also being explored and, specifically at Fox Chase, a variety of clinical trials are being conducted on this treatment for multiple myeloma, follicular lymphoma, and chronic lymphocytic leukemia.

Learn more about the Fox Chase-Temple University Hospital Bone Marrow Transplant Program

Despite oncologists’ best efforts, blood cancers sometimes come back or don’t respond to treatment. People with leukemia, lymphoma, or multiple myeloma can develop what’s called relapsed or refractory disease.

Michael Styler, MD, a hematologist/oncologist at Fox Chase Cancer Center, has the answers to some common questions about relapsed and refractory disease in patients with blood cancer:

What are relapsed and refractory diseases?

Relapsed disease means a cancer has come back. Refractory disease means a cancer has stopped responding to treatment.

“Most hematologic cancers, like leukemia, lymphoma, and multiple myeloma, are initially very sensitive to treatment. Patients very commonly go into remission when we treat them,” Styler said. “But ultimately, there may be some cancer cells that are just inherently resistant to those treatments, and over time, they start to multiply and the disease comes back again. At that point, it’s actually quite resistant to standard therapy.”

What is the difference in relapsed and refractory disease for each kind of blood cancer?

Relapsed and refractory disease can be different depending on the type of blood cancer:

• With leukemia, people who have been in remission can have a return of cancer cells and a decrease in normal blood cells. This is a relapse. Patients who still have cancer cells in their bone marrow after treatment have refractory leukemia.
• Relapsed lymphoma is a disease that responded to treatment initially, but then returned. Refractory disease means the cancer hasn’t responded to the initial treatment (it could be getting worse or staying the same).
• With multiple myeloma, almost all patients will experience a relapse or will see the disease become refractory.

How are relapsed and refractory blood cancers treated?

Relapses and disease that isn’t responding to treatment can seem dire, but at Fox Chase, effective treatment options are available.

“We can often overcome it by treating patients with very high-dose chemotherapy,” Styler said. “We pick drugs that we can safely increase the dose of, and we know will cause the patient to experience damage to their bone marrow cells.”

That might sound dangerous, but there’s a workaround to this damage—a stem cell transplant.

“To get around that side effect, we use stem cell transplant,” Styler said. “When the patient comes in for their treatment, they get the high-dose chemotherapy with the goal of trying to kill off those very resistant cancer cells. Then, we re-infuse the stem cells as a sort of rescue. This allows the patient’s cell counts to recover much more quickly and makes the whole process much more tolerable.”

Why Choose Fox Chase?

Our team of oncologists and bone marrow transplant specialists has been treating patients with relapsed and refractory disease for many years, offering the latest therapies and clinical trials.

“We have a very mature transplant program that is ranked very highly. It’s a multidisciplinary program with physicians who dedicate themselves specifically to transplants and taking care of patients undergoing transplants and cellular therapy,” Styler said. “We perform 100 to 150 stem cell transplants each year, and we’re pleased to offer many clinical trials. Our patients have access to the most recent advances and most promising treatments.”

Learn more about Fox Chase’s Department of Bone Marrow Transplant and Cellular Therapies

Bone marrow transplant (BMT), also known as stem cell transplant, is an advanced procedure used to treat a number of blood cancers such as acute leukemia, multiple myeloma, relapsed lymphoma, and other conditions. Here, Rashmi Khanal, MD, a hematologist-oncologist in the Department of Cellular Therapies and Fox Chase-Temple University Hospital Bone Marrow Transplant Program at Fox Chase Cancer Center, answers some important questions about BMT.

What happens during a BMT?

Bone marrow is the “soft tissue” inside the bones that makes blood-forming cells, which are also called stem cells. During a BMT, healthy stem cells are transplanted into the damaged or diseased marrow. The goal is for the healthy cells to promote the growth of fresh new marrow that is free of disease.

Which type of patient can benefit from BMT?

BMT can be used to treat blood cancers like advanced lymphoma, acute leukemia, and multiple myeloma (to name a few). BMT is often used as a second option when conventional chemotherapy hasn’t been effective to provide long-term disease control. But it can also be a first-line treatment for patients with very aggressive blood cancer.

That said, not every patient is a good candidate for a transplant. BMT is not well tolerated if you have other significant medical issues. And, because the transplant process is a major commitment, a strong support system is a must.

How does the procedure work?

Despite the surgical-sounding name, the process is similar to a blood transfusion. BMT starts with collecting healthy stem cells, either from the patient (autologous) or from a donor (allogenic).Then the patient is given additional chemotherapy to kill off any remaining cancerous cells and to condition the marrow. Immediately following this, the healthy stem cells are infused intravenously. As the cells make their way into the bone marrow, they start growing healthy new blood cells. The whole process typically takes 3–4 weeks (accounting for time for marrow recovery).

Can BMT cure blood cancer?

Yes. BMTs are often a cure for leukemia and late-stage lymphoma. But transplants are also beneficial for blood cancers that aren’t curable. For instance, BMT can offer a longer remission time for patients with multiple myeloma.

There are two main types of BMTs—autologous and allogenic. What’s the difference?

BMTs can either be autologous or allogenic. Autologous transplants use a patient’s own healthy stem cells and are typically performed on patients with advanced lymphoma or multiple myeloma. Allogenic transplants use donor cells, which can come from a family member or a donor registry. They’re typically used for MDS/leukemia patients but can also be a second option for lymphoma and multiple myeloma patients who didn’t have success with an autologous transplant.

Deciding which type of transplant a patient will receive is dependent upon a number of factors and one that your bone marrow transplant team will walk you through.

What are the risks of a BMT?

BMTs aim to wipe a patient’s bone marrow clean. That gives their marrow a fresh, healthy start—but it also creates an extremely high risk for infection. That’s especially true for allogenic transplant patients since they also have to take immunosuppressant drugs to keep their body from rejecting the donor cells. Transplants can also set the stage for anemia and bleeding problems. It is a very complex procedure and there are a number of factors that go into it. It is also a procedure that, for many patients, is life-saving.

Can a patient undergo a BMT more than once?

It depends. If a patient had an autologous BMT and it wasn’t effective, they may be able to attempt a second transplant or an allogenic transplant.

What should you look for when deciding where to have a BMT?

Seeking a comprehensive cancer center with hematologic oncologists who have dedicated experience with performing BMTs is a must. The center should also be accredited by the Foundation for the Accreditation of Cellular Therapy (FACT), which is a gold standard quality measure of excellence in both national and international standards. Just as important, you want access to a multidisciplinary care team that will support you through every aspect of your transplant—including psychological, social, and financial. Everyone on the team specializes in BMT—physicians, nurses, advanced practice clinicians, etc. The combination of all of these things makes the Fox Chase-Temple University Hospital Bone Marrow Transplant Program unique.