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Blood and Bone Marrow Stem Cell Transplantation for Older Adults

Andrew Artz, MD, examines a patient Andrew Artz, MD, leads the Older Adult Stem Cell Transplant Program.

Transplant Optimization Program (TOP)

The Transplant Optimization Program (TOP) at the University of Chicago Medicine is dedicated to optimizing blood and stem cell transplant for patients at least 50 years of age.

Read 70-yaer-old Hazel Strong's stem cell transplant story.

Our TOP clinic provides patients with a personalized supportive care plan that fosters more successful transplant outcomes. At the TOP clinic, our physicians and advanced practice nurses (APNs) start with a medical history assessment before your visit, followed by a full day of interdisciplinary evaluations, including:

After your visit, you'll attend a follow-up appointment with your primary physician outlining recommendations and a treatment plan.

For more information:

Older adult stem cell transplant team meets to discuss each patient's case.

Interdisciplinary Health Evaluations

Before Your Visit

Provider:
TOP clinic provider team

TOP clinic provider team

Before you come into the TOP Clinic, we will review your treatments for your disease, pre-transplant testing, medical history, and planned transplant details. You will also be asked about your general function, social support, emotional health and overall symptoms. You will be asked about this information to ensure accuracy and to give us a better perspective of your unique needs.

Follow these helpful tips to prepare for your visit.

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Transplant Medical Evaluation

(60 minutes, including two 30-minute sessions)

Providers:
Jean Ridgeway, APN, DNP (session one)
Andrew Artz, MD, MS (session two)

You will first see the advanced practice nurse and then Dr. Artz. The sessions will include a brief physical examination, and you will receive information about the day’s evaluations. Our providers will review the results from your surveys and ask additional questions about your understanding of the need for transplantation and your expectations. We will review your treatments, other medical conditions, your physical activity, available caregivers, and your emotional health.

Our providers will offer feedback and suggestions based on this evaluation.

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Geriatric Oncology Medical Evaluation

(30 minutes)

Providers:
Selina Chow, MD
William Dale, MD, PhD
James Wallace, MD

Your medical evaluation with a geriatric oncologist will help give your doctor an overall account of your medical history, as well as your current disease. This helps ensure the overall success of your transplant and regain a sense of “normalcy” after the procedure.

You can expect to discuss your other medical conditions, your day-to-day functioning, medications, mood, memory, and age-related issues that could affect your overall health.

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Infectious Disease Medical Evaluation

(30 minutes)

Provider:
Jennifer Pisano, MD

The infectious disease medical evaluation reviews any prior infections/exposures or risks for infection in everyday activities. The goal of this evaluation is to decrease your risk of infection after transplantation, as well as make a basic antibiotic plan, if needed.

You and the provider will review recent treatment courses, any infection-related complications, and any past treatments for infections, especially if you have been on antibiotics for more than two weeks or needed IV antibiotics for treatment. 

You will also discuss if you have lived abroad as well as any foreign travel that may place you at higher risk for reactivation of infections, or if there are other high-risk exposures or activities.

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Social Work

(45 minutes)

Provider:
Marc Paloma, LCSW

The comprehensive psychosocial assessment identifies any barriers you may encounter moving forward that may be a factor in the success of stem cell transplant. Such factors include financial, emotional, and physical aspects.

The goal is to make certain that, to the greatest extent possible, each patient has a supportive environment around them as they go through the transplant process, as well as afterward while in recovery. The social worker will ask questions about medication compliance, physical function, family/social support, and availability of a 24-hour caregiver after transplant.

You will also discuss tobacco and alcohol consumption, stress, and ability to cope with the disease and treatment.

It’s also important to discuss any feelings of anxiety and depression, insurance and medication coverage. If financial stress is a factor, grant funding may be available.

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Physical Therapy

(30 minutes)

Providers:
Betsy Campione, PT, DPT, CLT-LANA
Becca Spigel, PT, DPT, CLT-LANA, STAR/C

A physical therapist will evaluate your overall physical functioning.  During this session, the physical therapist will ask you questions regarding your current and previous physical function including normal day-to-day activities, exercise routines, and recreational activities.

Please dress comfortably as you will undergo a variety of tests including an assessment of your overall movement patterns, strength, walking mechanics, walking speed and balance, in addition to any other physical ailments you may identify. 

At the end of your session, exercise recommendations will be made in order to keep you strong and healthy as you prepare to undergo your transplant.

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Nutrition

(30 minutes)

Providers:
Valerie Reynolds, MS, RD, LDN, CNS

The purpose of the nutrition visit is for the dietitian to make sure you are nutritionally optimized prior to transplant. The dietitian assesses if there are any intolerance issues present or any barriers to food intake/appetite. During this evaluation, the clinician/dietitian will review weight trends, home eating patterns, and your ability to prepare your own meals. Based on information obtained, you will receive information with handouts on symptom management and goals as needed.

In addition, this visit is an opportunity to ask any questions regarding nutrition and diet after transplant and what nutrition amenities may be available while in the hospital. This visit is usually very quick unless there are many questions or issues.

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Health Status Survey

(30 minutes)

Providers:
Jessica Scott, BS, CRC
Alexis Small, BS, CRC

The health status survey measures your health and quality of life from your perspective. We'll send you an online survey link in an email for you to complete prior to your TOP clinic visit. That way, the information can be available to the team prior to your visit. If preferable, you can also complete the survey on paper on the day of your visit.

The survey covers your physical function, other health conditions, medications taken, social support, social activity, nutrition, and number of falls. This takes about 10 minutes. Another survey measures your quality of life both through your physical activity and your emotional health. This takes another 10-15 minutes.

During your visit, you will also complete several measures in the room led by a clinical research associate. These consist of a short walk, grip strength, and several questions related to your thinking. This takes about 5-10 minutes. The purpose of this clinical assessment is to establish a baseline of your mental and physical strength before and after transplant. As a patient you should expect to complete two questionnaires as well as walk tests, a grip strength test, and a brief cognitive test.

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After Your Visit

After all team members complete all evaluations, we have an interdisciplinary meeting. From this, formal written recommendations are provided to your transplant doctor, and also can be viewed by other team members to optimize your care throughout the transplant process.

You will attend a follow-up appointment with your primary physician outlining recommendations and a treatment plan.

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Support the TOP Clinic

If you wish to make a donation to support our work, please donate online and note in the “Special Instructions” field that your donation is for the Transplant Optimization Program.

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