Cells identified that enhance tumor growth and suppress anti-cancer immune attack

A study led by St. Jude Children’s Research Hospital scientists has identified the population of white blood cells that tumors use to enhance growth and suppress the disease-fighting immune system. The results, which appear in the December 18 edition of the scientific journal Immunity, mark a turning point in cancer immunology and provide the foundation for developing more effective immunotherapies.
For years, researchers have known that a diverse group of white blood cells called myeloid-derived suppressor cells (MDSC) are more abundant in cancer patients than in healthy individuals. The cells enhance cancer growth and suppress the specialized T cells that target and destroy tumor cells. MDSCs have a common origin in the bone marrow, but leave to travel throughout the body and become immune cells with different functions. Blocking T cells is one of the main MDSC functions.
Until now, however, efforts to distinguish among the cell types and identify the population responsible for anti-tumor immune suppression have fallen short. The puzzle has hampered efforts to harness the immune system to fight disease.
"We have identified the monocytic cells as the important cell to target, not only in cancer but possibly for treatment of autoimmune disorders like rheumatoid arthritis or inflammatory bowel diseases where dampening the immune response could provide relief," said corresponding author Peter Murray, Ph.D., a member of the St. Jude departments of Infectious Diseases and Immunology. "We also identified growth factors and other molecules essential to the survival and function of these monocytic cells. Targeting these molecules could lead to more precise approaches for controlling the immune response at the tumor site.
"This study marks a significant step in efforts to understand, develop and optimize immunotherapies for treatment of cancer," he said

Blincyto:for the treatment of Philadelphia chromosome-negative relapsed /refractory B cell precursor acute lymphoblastic leukemia

Blincyto (blinatumomab)Approved Dec. 2014: is an immunotherapy. It engages the body’s T-cells, a type of white blood cell or lymphocyte, to destroy leukemia cells. The drug acts as a connector between a protein called CD19, which is found on the surface of most B-cell lymphoblasts, and CD3, a protein on T-cell lymphocytes.
Blincyto is specifically indicated for the treatment of Philadelphia chromosome-negative relapsed or refractory B-cell precursor acute lymphoblastic leukemia.
Blincyto is supplied as a solution for intravenous infusion. Hospitalization is recommended for the first 9 days of the first cycle and the first 2 days of the second cycle. For all subsequent cycle starts and reinitiation (eg, if treatment is interrupted for 4 or more hours), supervision by a healthcare professional or hospitalization is recommended. Do not flush the Blincyto infusion line, especially when changing infusion bags. Flushing when changing bags or at completion of infusion can result in excess dosage and complications. The recommended dosing schedule is as follows:
A single cycle of treatment of Blincyto consists of 4 weeks of continuous intravenous infusion followed by a 2-week treatment-free interval.
• For patients at least 45 kg in weight:
- In Cycle 1, administer Blincyto at 9 mcg/day on Days 1–7 and at 28 mcg/day on Days 8–28.
- For subsequent cycles, administer Blincyto at 28 mcg/day on Days 1–28.
• Allow for at least 2 weeks treatment-free between cycles of Blincyto.
• A treatment course consists of up to 2 cycles of Blincyto for induction followed by 3 additional cycles for consolidation treatment (up to a total of 5 cycles).

Adverse effects associated with the use of Blincyto may include, but are not limited to, the following:

• pyrexia
• headache
• peripheral edema
• febrile neutropenia
• nausea
• hypokalemia
• tremor
• rash
• constipation

In addition, Cytokine Release Syndrome (CRS) and neurological toxicities, both of which may be severe, life-threatening, or fatal, occurred in patients receiving Blincyto. Interrupt or discontinue Blincyto as recommended.

For additional information regarding Blincyto or Philadelphia chromosome-negative relapsed /refractory B cell precursor acute lymphoblastic leukemia, please visit www.amgen.com

New Cancer Therapy Drug: Gilead; for the treatment of relapsed CLL, follicular B-cell NHL

Zydelig (idelalisib) is a small molecule inhibitor of phosphoinositide-3 kinase (PI3K) delta, an intracellular signaling component. PI3K-delta is expressed primarily in blood-cell lineages, including cells that cause or mediate hematologic malignancies.
Zydelig is specifically indicated for the following:

• Relapsed chronic lymphocytic leukemia in combination with rituximab, in patients for whom rituximab alone would be considered appropriate therapy due to other co-morbidities.
• Relapsed follicular B-cell non-Hodgkin lymphoma in patients who have received at least two prior systemic therapies. 
• Relapsed small lymphocytic lymphoma in patients who have received at least two prior systemic therapies

Zydelig is supplied as a tablet for oral administration. The recommended maximum starting dose of Zydelig is 150 mg administered orally twice daily. Zydelig can be taken with or without food. Tablets should be swallowed whole. Continue treatment until disease progression or unacceptable toxicity.

Adverse effects associated with the use of Zydelig may include, but are not limited to, the following:
diarrhea
pyrexia
fatigue
nausea
cough
pneumonia
abdominal pain
chills
rash

For additional information regarding Zydelig or relapsed chronic lymphocytic leukemia, relapsed follicular B-cell non-Hodgkin lymphoma and relapsed small lymphocytic lymphoma, please visit www.zydelig.com

U.S. Approves Skin Cancer Treatment

U.S. regulators Monday approved Bristol-Myers Squibb Co. ’s Opdivo for advanced skin cancer, the latest drug to reach the market in the emerging field of cancer immunotherapy.
The decision by the Food and Drug Administration means Bristol-Myers now has two drugs on the market that work by unleashing the body’s immune system to attack tumors, helping to solidify the company’s lead in an area of cancer treatment that has drawn wide interest across the pharmaceutical industry.
It also comes amid a flurry of year-end drug approvals by the federal agency, including three last Friday. Opdivo, which is also known by the chemical name nivolumab, is the eighth new drug to reach the market in the past four years for late-stage melanoma, a historically lethal disease.
Bristol-Myers officials said the company plans to charge an average of $12,500 a month for the treatment, the same price as the rival drug Keytruda from Merck & Co., which was approved in September. Both drugs target a protein called PD-1, a molecular brake that prevents the immune system from seeing tumors as invaders and enables cancer to avoid attack.
The two drugs are approved for patients who fail to respond to certain other medicines including Yervoy, another Bristol-Myers immunotherapy drug that was approved for advanced melanoma in 2011 and that works by releasing a different immune system brake.
All three drugs belong to a class of agents known as checkpoint inhibitors that, by unleashing an immune system attack against cancer, are enabling significant numbers of patients to live years longer than would otherwise be expected. Roche Holding AG and AstraZeneca PLC are among other companies testing agents against immune system brakes.
Approval of Opdivo “is a confirmation of the strength of our strategy” to focus the company’s efforts on cancer immunotherapy, said Giovanni Caforio, Bristol-Myers’s chief operating officer. “The ability to come to the market with a second very important medicine is something we’ve been working for and we’re very proud of it.”
The approval, which came under the FDA’s so-called breakthrough designation initiative, was based on the experience of 120 participants in a continuing clinical trial, among whom 32% had significant tumor shrinkage. The effect lasted for more than six months in about one-third of such patients, the FDA said.
The most serious side effects included a severe immune response against healthy organs, including the lung, and were generally managed by using aggressive treatment with steroids.

Cancer drug developer caps busy year for IPOs, especially by biotech firms

Juno Therapeutics Inc. shares surged 63% in their market debut Friday, after a flurry of demand for the year’s last expected new offering led the biotech firm to price above its already-boosted range.
Juno, which develops cancer treatments that use the body’s own immune system to fight the disease, began trading Friday on the Nasdaq at $39 a share JUNO, +45.83% after pricing 11 million shares at $24.
The open price of $39 values Juno at more than $3 billion, the largest valuation for a biotech going public since IPO research firm Renaissance Capital began tracking this kind of data a little over a decade ago. Juno’s valuation comes despite the fact that the biotech has no revenue, has never reported a profit and has no drug candidates in late-stage trials.

I.P.O. of Juno Therapeutics, Developer of a Cancer Treatment, Excites Investors

Excitement over a promise of a new type of cancer treatment ignited a frenzy on Wall Street Friday as a little-known year-old company pulled off one of the largest initial public stock offerings in the biotechnology sector.

The company, Juno Therapeutics, sold 11 million shares at $24 each on Thursday in its initial public offering. The company increased its price and the number of shares offered earlier that day after a surge in demand.

When trading started on Friday, the stock soared, closing at $35 a share, up 46 percent, and giving Juno a market valuation of about $2.7 billion.

Juno, based in Seattle, is working on sophisticated treatments that genetically engineer the body’s immune cells so they can better recognize and kill cancer cells. Its approach has been tried so far on a relatively small number of patients, but the results have been extraordinary. Some people with leukemia have been rescued from near-certain death. A study of one of Juno’s drugs found an 89 percent remission rate among 27 adults with acute lymphoblastic leukemia no longer responding to other treatments.

Juno has collaborations with the Fred Hutchinson Cancer Research Center in Seattle, Seattle Children’s Research Institute and the Memorial Sloan Kettering Cancer Center in New York, and they could be in for a windfall if the company succeeds.

In addition to the usual royalties and milestone payments that companies pay to suppliers of technology, Juno will make “success payments” to the Hutchinson center and Sloan Kettering if the company’s stock is above certain prices at certain points in time. The total payments could be as much as $375 million in cash and stock for the Hutchinson center and $150 million for Sloan Kettering.

Even before raising $264 million its public offering, Juno had raised more than $300 million privately, a large amount for such a young firm. One early investor was Jeff Bezos, head of Seattle-based Amazon. Juno’s largest shareholder, with about a 30 percent stake, is a fund that invests the State of Alaska’s oil revenue

A new strategy for developing drugs to fight Cancer and other diseases

Promising treatments known as biologics are on the market and under development for many serious illnesses such as cancer, but some of them come with high risks, even lethal ones. Now scientists have produced a novel class of molecules that could be as effective but without the dangerous side effects. They report their work on these compounds, which they tested on prostate cancer cells, in ACS' Journal of the American Chemical Society
David A. Spiegel and colleagues explain that biologics are protein-based therapies that have revolutionized cancer treatment over the past decade. These compounds work by latching onto malignant cells and then triggering the immune system to destroy them -- an approach known as immunotherapy. More than 400 kinds are currently undergoing testing in clinical trials. Although they're very effective at clearing out cancer cells, biologics have serious drawbacks -- including potentially fatal allergic reactions -- that are mainly due to their relatively large size. Spiegel's team wanted to develop an alternative that would be just as effective but without the risks.
The researchers produced a set of molecules that they call synthetic antibody mimics, or SyAMs. These molecules act like biologics by sparking an immune response but are far smaller. In lab tests, a subgroup called SyAM-Ps worked well against prostate cancer cells. Because of their small size, the researchers suggest that SyAMs could avoid many of the pitfalls that have plagued biologics. The compounds could represent an entirely new direction in immunotherapy for treating cancer and other diseases, the researchers conclude.

There are three kinds of Bone Marrow or Stem Cell Transplants

• A bone marrow transplant is a procedure to replace damaged or destroyed bone marrow with healthy bone marrow stem cells.
  Bone marrow is the soft, fatty tissue inside your bones. Stem cells are immature cells in the bone marrow that give rise to all of your blood cells.
   
• Autologous bone marrow transplant: The term auto means self. Stem cells are removed from you before you receive high-dose chemotherapy or radiation treatment. The stem cells are stored in a freezer (cryopreservation). After high-dose chemotherapy or radiation treatments, your stems cells are put back in your body to make (regenerate) normal blood cells. This is called a rescue transplant.
• Allogeneic bone marrow transplant: The term allo means other. Stem cells are removed from another person, called a donor. Most times, the donor's genes must at least partly match your genes. Special blood tests are done to see if a donor is a good match for you. A brother or sister is most likely to be a good match. Sometimes parents, children, and other relatives are good matches. Donors who are not related to you may be found through national bone marrow registries.
• Umbilical cord blood transplant: This is a type of allogeneic transplant. Stem cells are removed from a newborn baby's umbilical cord right after birth. The stem cells are frozen and stored until they are needed for a transplant. Umbilical cord blood cells are very immature so there is less of a need for matching. But blood counts take much longer to recover.

Pioneering a new Treatment that Heats the Blood, Kills Cancer Cells

A new cancer-fighting strategy that kills deadly cells by raising body temperatures is heating up in the Bay Area.
Whole body hyperthermia is a cancer therapy in which the patient’s body temperature is raised high enough to kill cancer throughout the body.
“Cancer cells are not normal.  They don’t repair themselves well, and are subject to being destroyed by methods your cells can handle,” Dr. James Lilja stated.  Doctors at San Jose’s Good Samaritan Hospital are using pioneering the research.  The method uses tubes outside the patient’s body to heat blood with hot water to well over 100 degrees before it’s re-infused.
The therapy lasts about two hours, long enough to kill only the cancer, and a special filtering system keeps the blood from going bad.
“By using this kind of a system we’re able to remove, we think some of the unknown dangerous chemicals that are released by the body,” Dr. Roger Vertrees said.
Two patients have been treated in the first clinical trial, and have been able to return to work.
“The hope for this therapy is that it becomes a standard modality for treating cancer like chemotherapy, radiation and surgery,” Dr. Vertrees said.
Good Samaritan is looking for other patients with ovarian cancer to participate in its clinical trials

Shorter Radiation therapy Not a Bad Idea

“I started my residency in 1993,” Dr. Freedman said. “That was drilled into us”: Shorter and more intense radiation therapy “was a bad idea and would have a bad cosmetic result.”

But with improved equipment and methodology, he said, the clinical trials found that cosmetic results were just as good with the shorter treatment. “They did not just publish that the cure rates were the same, but they published very in-depth cosmetic assessments, particularly the British, who took pictures that were graded by blinded observers,” he said.

“That’s when the tide started turning.”

Shorter Radiation Therapy vs the standard in Breast Cancer Treatments

In Canada and Britain, the statistics were far different. At least two-thirds of women in both groups received the shorter therapy.

In the United States, total medical expenses for the shorter therapy in women for whom it was endorsed were $28,747. For comparable women receiving the longer course of treatment, the cost was $31,641. For the second group of women — for whom the shorter therapy was neither endorsed nor discouraged — medical costs were $64,723, compared with $72,860 for conventional therapy. Health insurers pay for radiation in a piecemeal fashion, and the shorter course involves about 16 doses, compared with about 33 with the conventional therapy.

Dr. Harold J. Burstein, a medical oncologist at Dana-Farber Cancer Institute in Boston, said that when the initial results of a Canadian trial on the shorter therapy were published in 2002, “there was real ambivalence about changing practice based on one study.” Doctors wanted to see what would happen as the women were followed over a longer time, and they wanted to see the result confirmed.

The results of that study contradicted years of practice in the field, said Dr. Gary M. Freedman, a breast radiation oncologist at the University of Pennsylvania and an author of the new study. In the 1970s and 1980s, when equipment was much less sophisticated, radiation oncologists found that shorter and more intense therapy burned women’s skin and scarred their breasts, making them shrivel and shrink over the ensuing decade.

A New study on Radiation in Breast Cancer Therapies

In the new study, published Wednesday in JAMA, The Journal of the American Medical Association, two University of Pennsylvania doctors, Ezekiel J. Emanuel and Justin E. Bekelman, and their colleagues analyzed data from 14 commercial insurance plans involving 15,643 women who had their breasts irradiated after lumpectomies.

Radiation is used after women have lumpectomies because it reduces the odds that another cancer will arise in the breast, and it improves the chances of survival.

The researchers considered two groups of women who had radiation therapy and asked how many had received the shorter course. One group closely matched women in the previous randomized studies that evaluated the conventional treatment versus the shorter one. These women were older than 50 and had early-stage cancers. Practice guidelines published in 2011 by the American Society for Radiation Oncology recommend the shorter radiation therapy for this group.

The other group differed from participants in the previous studies because they were younger, had had prior chemotherapy or had cancer cells in their lymph nodes, indicating a more advanced cancer. The practice guidelines neither endorse nor discourage the shorter therapy for these women.

Use of the shorter course of radiation increased in both groups of women from 2008 to 2013, but still only a minority received this treatment. In the group that should have received the shorter therapy under the guidelines, 10.6 percent received it in 2008 and 34.5 percent in 2013. In the group that received no recommendation for or against the shorter treatment, the percentage who used it rose from 8.1 percent to 21.2 percent over that time.

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In Canada and Britain, the statistics were far different. At least two-thirds of women in both groups received the shorter therapy.

Long radiation treatments faulted in many Breast Cancer cases

Two-thirds of women who have lumpectomies for breast cancer are receiving radiation treatment that lasts nearly twice as long as necessary, a new study reports.

The conventional, longer treatment lasts five to seven weeks. But four rigorous studies and guidelines from a leading radiology society conclude that three to four weeks of more intense radiation is just as effective.

Women overwhelmingly prefer the shorter course of radiation, studies have found. It is also less expensive.

Even though 60 to 75 percent of women with breast cancer have lumpectomies — a total of about 140,000 to 160,000 women — doctors and health insurers say relatively few are receiving the shorter treatment because it takes time to change ingrained medical practices, especially when a procedure has been used for decades and the new one offers no additional medical benefit. Its advantages are saving time for patients, and money for the health care system and insurers.

“If a physician is doing five to seven weeks of radiation for 25 years, particularly if the physician is not a specialist and not in an academic medical center, you will be a bit leery about going to something new,” said Dr. Bruce G. Haffty, a professor and chairman of the department of radiation oncology at the Rutgers Cancer Institute of New Jersey. “You are comfortable with the outcomes, patients are satisfied. Now you’ve got something that perhaps costs a bit less, but you wonder: Is it as effective?”

New Cancer Treatments Represent Major Breakthroughs

Corey Wood was a week away from her graduation from the University of California at Berkeley when she started getting flashes in one of her eyes. Her doctor was concerned and had an inkling that something serious was going on, so he took the unusual step of ordering a body scan. Corey was a healthy 22 year old who was tremendously fit and who had already completed eight marathons. Yet, stunningly, her tests revealed that she had stage IV lung cancer. The flashing of light she was experiencing was caused by a tumor behind her eye. But the disease was also in her lungs where there were multiple tumors and the disease had rapidly metastasized to her bones. Her prognosis wasn’t very good.
However, a sample of her tumor was sent to Foundation Medicine for genomic analysis and it was found that her cancer was being driven by an ROS-1 genetic alteration. Fortunately, a drug had been recently approved to treat this very type of cancer – Pfizer’s Xalkori (crizotinib). Xalkori is one of the new generation of drugs called targeted therapies, drugs specifically designed to treat Corey’s ROS-1 driven cancer in a way that does not cause the concomitant horrific side effects associated with traditional chemotherapy. After taking two Xalkori pills a day for three months, all the while going about her normal activities, Corey was cancer free.
Corey shared her inspirational story yesterday at the Forbes Healthcare Summit held in New York City. The eradication of her disease shows the power of the tools available to treat cancer that were thought of as science fiction just a decade ago, such as whole body scanning, genomic analysis of her tumor, and having a targeted drug available in the pharmacy to eradicate her disease. This approach to treating cancer is only going to get better. There are hundreds of targeted therapies in development in the pipelines of dozens of biopharmaceutical companies. There are other breakthroughs being made as well, particularly in the exploding field of immuno-oncology where drugs such as Yervoy (Bristol-Myers Squibb) and Keytruda (Merck) are helping to stimulate a cancer patient’s immune system to fight the cancer. These are incredibly exciting times.
After Corey’s talk, Forbes’ Matt Herper led a panel discussion with Peter Bach (Memorial Sloan Kettering Cancer Center), Bob Hugin (CEO, Celgene CELG +0.41%), Richard Klausner (CMO, Illumina ILMN -1.42%), and Sandra Swain (Medical Director, Washington Cancer Institute). The session tried to answer the question “Are we at a tipping point for cancer and are we on the doorstep of vanquishing this disease?” This was a great discussion about changing treatment paradigms, access to healthcare, and emerging science. But Bach brought the group to the key issue facing oncology – the costs of treatment. Yervoy and Keytruda are great drugs, but they cost $120,000 and $150,000 per year, respectively. Furthermore, these drugs are not going to be used as stand-alone agents. Rather they will be used in combination with other drugs such as targeted therapies.
The good news is in the not too distant future, a cancer diagnosis will not be a death sentence. Rather, this will be a treatable condition controlled by taking a combination of these breakthrough therapies. However, people may require a combination of these therapies for the rest of their lives. Imagine millions of people needing a cocktail of three drugs, each of which costs $100,000/year/patient. It doesn’t take major economic analyses to realize that the costs inflicted on the healthcare system will not be sustainable in such a scenario

On Targeted Therapies for Cancer

It has only been recently that the understanding of the atlas, the periodic table of changes that are resident within cancer cells, the spectrum of mutations that occur in various cancers, be it breast,  prostate or colon. Without knowledge of that periodic table, without knowledge of the genes that are aberrant in those cancers, it’s very difficult to treat those cancers with therapies that are squarely against impacting that specific cancer. If we could have an understanding of those genetic mutations then we would be able to develop targeted therapies for those cancers, and have those cancers elicit more durable responses for patients with the disease. The approach that has been taken for decades, is one of a more general approach to cancer, that involves chemotherapy, radiation and surgery, which have made a huge impact on the cancer problem, but we’re now at the threshold of a time where we can begin to understand exactly what’s wrong in a person’s cancer and tailor the therapies.

A possible Vaccine for Cancer ?

The vaccine that is being referred to is for a particular type of breast cancer called HER2-positive breast cancer. So there‘s a receptor that drives that disease and the drug Herceptin is used for those patients so that drug plus surgery and radiation has led to significant improvement in survival, but there are still some patients that recur and ultimately succumb to the disease. Elizabeth Mittendorf, who led a trial at MD Anderson Cancer Center, asked the question: "After treatment if we were to give those patients several rounds of this vaccine, which has this abnormal HER2 protein packaged in it, would we reduce the rate of recurrence?’ The results were striking. We had a very significant reduction in the recurrence of rates with about a 50 percent reduction which will translate into thousands of lives each year with women with that particular breast cancer."

Manipulating Immune Cells to Fight Cancer is Working!

“It’s not just a handful of patients. It’s an expanding number at multiple centers,” says Renier Brentjens, MD, PhD, an oncologist at Memorial Sloan Kettering Cancer Center, who has spent 20 years researching ways to manipulate immune cells to fight cancer. “That’s often an indication that you’re not looking at a one-patient thing or a fluke. It really works in this disease.”

Since 2009, researchers at Sloan Kettering, the University of Pennsylvania, and the National Cancer Institute have tried this treatment on about 100 patients with ALL. More than 70 have gone into complete remission. Results like this earned the treatment its breakthrough status at the FDA.

“This is a very, very bad disease. The 3-year overall survival after relapse is less than 10%,” Brentjens says. “Most of the patients that we’ve seen for a 6-month visit after the T-cell therapy are at or past what their expected survival was when they first came into our clinic.”

Researchers continue testing modified T-cells in patients with other types of leukemia, lymphoma, and myeloma -- all blood cancers. “The question is: Can we expand this technology to more common tumors? Colon cancer, ovarian cancer, breast cancer,” Brentjens says. Early research in this area says the answer could be “yes."

Immunotherapy Brings New Hope to Cancer Fight

The treatment, called CAR T-cell therapy, re-engineers a patient’s own immune system to recognize and attack cancer cells. This July, FDA gave CAR T-cell therapy "breakthrough therapy" designation, which fast-tracks its path to FDA approval.

CAR T-cell therapy is a type of immunotherapy, a new wave of experimental and newly approved treatments that spur the immune system to fight cancer like it does other illnesses. Immunotherapy dominated talks at this year’s American Society of Clinical Oncology meeting. Some doctors and scientists are calling it the pathway to a cure. This year the FDA has approved two more immunotherapy drugs for the treatment of melanoma and chronic lymphocytic leukemia, including pembrolizumab (marketed as Keytruda), which was approved for melanoma last month.

“We are supercharging the immune system” says Lynn Schuchter, MD, chief of hematology oncology and an immunotherapy researcher at the University of Pennsylvania. “This brings a totally new dimension to attacking a cancer cell.”

New Vaccine for Breast Cancer

The study, published in Clinical Cancer Research, also suggests the vaccine primes patients' white blood cells to attack tumor cells, slowing down the progression of the cancer.
The new vaccine works by targeting a protein called mammaglobin-A that is predominantly found in breast tissue. Its role in healthy tissue is currently unknown, but previous research has shown that breast tumor cells express the protein at abnormally high levels.
"Being able to target mammaglobin is exciting because it is expressed broadly in up to 80% of breast cancers, but not at meaningful levels in other tissues," says senior author Dr. William Gillanders. "In theory, this means we could treat a large number of breast cancer patients with potentially fewer side effects."
Many pre-existing drug treatments for breast cancer target another protein called human growth factor receptor 2 (HER2). These treatments, including trastuzumab and pertuzumab, can have side effects that include diarrhea and heart problems.

Bone Marrow, or Stem Cell Transplant alternate names

Transplant - bone marrow; Stem cell transplant; Hematopoietic stem cell transplant; Reduced intensity, nonmyeloablative transplant; Mini transplant; Allogenic bone marrow transplant; Autologous bone marrow transplant; Umbilical cord blood transplant

Outlook (Prognosis) of Stem Cell Transplant

How well you do after transplant depends on:

• The type of bone marrow transplant
• How well the donor's cells match yours
• What type of cancer or illness you have
• Your age and overall health
• The type and dosage of chemotherapy or radiation therapy you had before your transplant
• Any complications you may have

A bone marrow transplant may completely or partially cure your illness. If the transplant is a success, you can go back to most of your normal activities as soon as you feel well enough. Usually it takes up to 1 year to recover fully.
Complications or failure of the bone marrow transplant can lead to death.

After the Bone Marrow or Stem Cell Transplant

A bone marrow transplant is usually done in a hospital or medical center that specializes in such treatment. Most of the time, you stay in a special bone marrow transplant unit in the center. This is to limit your chance of getting an infection.
Depending on the treatment and where it is done, all or part of an autologous or allogeneic transplant may be done as an outpatient. This means you do not have to stay in the hospital overnight.
How long you stay in the hospital depends on how much chemotherapy or radiation you received, the type of transplant, and your medical center's procedures. While you are in the hospital, you will be isolated because of the increased risk of infection. The health care team will closely monitor your blood count and vital signs.
While you are in the hospital you may:

• Receive medications to prevent or treat infections, including antibiotics, antifungals, and antiviral drugs
• Need many blood transfusions
• Be fed through a vein (IV) until you can eat by mouth and stomach side effects and mouth sores have gone away
• Be given medications to prevent graft-versus-host disease