IBMT is a research-oriented organization, providing its patients with the best assets of both academic and private practice settings. While its physicians and staff are on the cutting edge of leading bone marrow transplant ("BMT") technology, the patient still has the benefit of being able to access fully credentialled physicians at any hour of the day or night.

IBMT offers treatment for both autologous and allogeneic patients. Its unique Outpatient Clinic model enables patients the opportunity to undergo the transplant process in the Outpatient Clinic during the day and to stay in nearby garden homes at night.

Introduction to the IBMT Program

Facilities

One of the great advantages IBMT offers to its patients is its broad range of on-site facilities. IBMT's Outpatient Clinic is a self-contained dedicated entity with its own full-time staff. Within the Clinic, peripheral blood stem cell collection, chemotherapy and reinfusion occur. The Clinic is located adjacent to the Inpatient BMT Unit.

The Program's cryopreservation facility gives specialists the capability to indefinitely freeze cells from both donors and patients. To date, laboratory personnel have processed over 1,000 stem cell specimens. The laboratory also performs the most advanced processing of bone marrow and blood collections to improve the efficacy of the transplant procedures. This facility enables IBMT to serve as a collection center for the National Marrow Donor Program for unrelated donors.

The Clinic utilizes the services of St. Francis HLA and Vascular Biology Laboratory to perform state-of-the-art tissue typing. The St. Francis Radiation Therapy Department treats patients who require total body irradiation. IBMT provides all lab services on site along with the Department of Laboratory Medicine.

The Inpatient Unit at St. Francis Hospital - Beech Grove serves as its own intensive care unit, a separate floor of the hospital. It houses 17 transplant rooms, each equipped with HEPA filters to minimize the chance of infection. It also features family lounges for the comfort of families, friends, and recovering patients.

IBMT and St. Francis Hospital lease several garden homes within walking distance of the hospital to house families of patients as well as patients undergoing outpatient transplants who are from out of town. Patients are able to stay within reach of their full team of IBMT professionals for as long as their recovery requires. Reasonable rates and convenient location make these “home away from home” the preferred choice of many patients and their families.

Services

The Indiana Blood and Marrow Transplant program performs the following procedures as outpatients within the clinic:

• Chemotherapy
• Harvesting of blood stem cells
• Stem cell preservation, utilizing standard automated separation procedures and controlled-rate cryopreservation
• Reinfusion of stem cell products
• Infusion of antibiotics, nutrition, and other solutions
• Transfusion of blood products

The Patient's Experience

Bone Marrow Transplant Treatment

Bone marrow is a spongy tissue, responsible for the body's generation of white blood cells, red blood cells and platelets. It is instrumental in a patients' recovery from chemotherapy / radation treatments which can be very damaging. Transplantation of bone marrow (or peripheral blood stem cells) allows a patient to receive more intensive chemotherapy and/or radiation therapy treatments in one of two ways:

• In an autologous transplant, the physician will remove some of this cell-generating substance from the patient before chemotherapy / radiation therapy, possibly purge it of lingering malignant cells, and reinfuse it after the treatment. This process protects the patient from potentially permanent damaging effects of chemotherapy / radiation therapy on the bone marrow.

• In an allogeneic transplant, the patient is infused with a healthy person's bone marrow after chemotherapy / radiation treatment.

In either case, chances of killing off the disease and making a strong recovery are substantially increased. During the last five to ten years, stem cells for transplantation are being obtained increasingly from the blood stream instead of from the bone marrow.

In The Clinic

If a donor's bone marrow or peripheral blood stem cells are used, careful screening must be done to ensure that the product closely matches that of the patient. Siblings have the best likelihood of being suitable donors with about a 30% chance of match. IBMT participates in the National Marrow Donor Program to help patients nationwide who are seeking a match from an unrelated volunteer donor if there is no sibling match.

Marrow is harvested from the patient's or donor's hip bone under general anesthesia in an outpatient (or inpatient) procedure. If peripheral blood stem cells are to be used for the transplant, they are collected over several days in the outpatient clinic. Either may be cryogenically preserved in IBMT's on-site laboratory until ready for use.

To increase patient comfort for the numerous required blood tests and ease the administration of drugs, a catheter is placed in the patient's chest for instant venous access. The patient then receives several days of high-dose chemotherapy or radiation.

Intravenous infusion of bone marrow or peripheral blood stem cells lasts from one half to two hours. The patient's condition is monitored constantly for signs of fever or reaction. A family member or caregiver should be present during the transplant to provide emotional support.

In the first few days after the transplant, the new bone marrow must "engraft", or begin to function within the patient's body. Until this occurs, the patient is highly susceptible to infection and will be closely monitored on a daily basis. Patients with high fever or other complications will be admitted to the hospital's BMT unit for continuous surveillance. Those who respond favorably may stay home or in the hotel until recovery.

Outpatient Treatment

IBMT's unique outpatient program allows certain patients to recover in the comfortable surroundings of home or a home-like environment. In order to be considered an outpatient candidate, the patient must have access to a full time non-medical caregiver ("attendant") who can be present for the transplant and for patient assistance during the first few weeks of recovery. Autologous patients must also have transportation available to and from the clinic in order to attend daily follow-up visits. Patients who live more than one hour's drive away from the clinic must recover in the hospital's on-site hotel. Limousine services ensure safe and comfortable transportation to the clinic for patients arriving and departing via Indianapolis International Airport.

After the transplant, medical staff monitor the patient's progress and decide whether a hospital stay in the Bone Marrow Transplant Unit would be appropriate.

Ambulatory care patients receive extensive instructions regarding the strict precautions required in terms of environment and diet, in order to avoid infection. If needed, outpatients receive antibiotics to combat infection during the susceptible early recovery period, just as they would if hospitalized.

Normal outpatient clinic staffing consists of at least five registered nurses at all times. The current nursing team's combined experience in Bone Marrow Transplant totals over 50 years. IBMT's continuing education policy affords each nurse the opportunity to maintain current knowledge, competency, and training in the field of bone marrow transplantation. Extensive nurse training ensures appropriate patient and family teaching which, in turn, decreases anxiety and complications, and improves treatment outcome.

Eligibility

IBMT physicians must reach the consensus that bone marrow transplant is the appropriate course of action. Each patient is evaluated based on general physical condition, disease process, age, co-morbid conditions, and prognostic indicators. Patients participate in Institutional Review Board (IRB) approved treatment protocols. IBMT considers the following conditions treatable and/or curable with bone marrow transplantation:

• Aplastic anemia
• Adult and childhood acute myeloid leukemia (AML)
• Adult acute lymphocytic leukemia (ALL) and high-risk childhood ALL
• Adult and childhood chronic myeloid leukemia (CML)
• Preleukemic syndromes (myelodysplastic syndromes)
• Malignant lymphomas (Hodgkin's and non-Hodgkin's)
• Multiple myeloma
• Neuroblastoma
• Breast cancer
• Ovarian cancer
• Testicular cancer
• Renal Cell cancer
• Other rare diseases for which stem cell transplant has been shown to be effective

Physician Staffing

Four full-time Bone Marrow Transplant physicians, who have performed hundreds of autologous and allogeneic transplants and undertaken extensive research in the field, staff IBMT.

Because every patient receives 24 hour care by the attending IBMT physician, all management decisions are made by an experienced transplanter. Additional doctors serve as consultants overseeing infectious diseases, pulmonary medicine, radiology, pathology and radiation therapy. A team of surgeons experienced in the field of transplantation provide general surgery services for BMT patients.

The staff of Indiana Blood and Marrow Transplantation coordinate all efforts to make IBMT the nation's optimal program in bone marrow transplantation.

IBMT is an approved network provider for URN-United Resource Networks; Anthem-BQCT network, Medical Excess-Specialty Care Network, Humana’s National Transplant Networks, SIHO- Southeastern Indiana Health Operation/Organization Inc., St. Francis Health Network