Overview

Preparation

Advances in the treatment of cancer and improvements in supportive care over the past 10 years have improved the results and tolerability of bone marrow transplants. However, a bone marrow transplant remains a dangerous and difficult procedure. For allogeneic transplantation, the patient receives bone marrow or blood stem cells from a donor who may or may not be a relative. Identical twin allogeneic transplants are called syngeneic transplants.

Procedure

High Dose Chemotherapy

Chemotherapy begins soon after you are admitted to the hospital. Your doctor will discuss all of the drugs you will receive and their side effects. Your nurse practitioner, inpatient nurse and pharmacist also will be available to answer questions. In addition, you may receive written information on these drugs in the consent form. Precautions are taken to minimize side effects from these drugs. For example, when receiving some types of chemotherapy, patients must shower thoroughly twice a day to remove the drug that is excreted through the skin -- this is done to help prevent severe skin rashes. The inpatient nurse will go over any special precautions that you may need to take.

Total Body Irradiation

Some patients receive total body irradiation (TBI) in addition to chemotherapy. This radiation therapy is intended to destroy remaining cancer cells and further suppress the immune system. TBI treatments are given in the radiotherapy department usually over a period of three to four days. The treatment itself is painless, but there may be uncomfortable side effects after treatment, such as mouth and throat sores, nausea, stomach and intestinal irritations, and skin redness. Antinausea medication is usually given before each treatment to reduce nausea.

The Transplant Procedure

The transplant or stem cells will be infused one to three days after the last chemotherapy or radiation dose. The day of transplantation is referred to as Day 0. The days before the transplant are counted as minus days and the days after the transplant are plus days.

The transplant procedure is similar to a simple blood transfusion and will be done in your hospital room. You may have a family member in the room with you if you wish. The actual procedure will take approximately 45 minutes, depending on the volume of stem cells. The blood stem cells will be infused through your central venous catheter just like a regular blood transfusion. Your nurse will check your blood pressure, temperature, breathing and pulse, and will watch for any side effects. Usually there are no side effects, but occasional patients may experience chills, flushing of the face, nausea and vomiting, headache, and changes in blood pressure and breathing. Your urine also may be tinged red for the first 24 hours after transplantation. However, if your urine remains red after this time or becomes red later, tell your nurse.
Waiting For Engraftment

The new bone marrow does not recover immediately after it has been transplanted. The stem cells of the transplanted marrow will travel to the bones, reseed the marrow space, and go through a growth process before the mature cells are released from the bone marrow into the blood stream. It takes approximately two to three weeks for your marrow to start producing white blood cells, red blood cells and platelets.

Engraftment is the term used to describe when your new marrow begins to function and produce cells. While awaiting engraftment, no mature cells leave the marrow and enter the blood stream. Your blood counts will show very low values and you will require careful monitoring by the health care team. The goal is to support you with red blood cell and platelet transfusion until you are producing cells again.

Recovery

Delayed Side Effects

The body feels the effects of the chemotherapy or radiation about a week after a bone marrow transplant. When the blood counts are low, you feel like you have the flu and may not want to do much. This will last for about two weeks and will decrease as your blood counts improve. You may notice a number of other symptoms as well, including:

• Loss of appetite
• Nausea and vomiting
• Changes in vision
• Mouth and throat soreness
• Diarrhea
• Difficulty sleeping and fatigue
• Infection
• Hair loss
• Skin reactions
• Graft-versus-host disease

Find detailed information about these side effects in the section of the Allogeneic Transplant Guide.

Preparing to Leave the Hospital

When your neutrophil count is over 1000, your team will start talking to you about discharge. You will need to be sure that arrangements have been made for someone to stay with you after you are discharged, to assist you with daily needs and to be available for clinic visit transportation. You or a family member will learn how to care for your catheter.

To be discharged, you will need to be:

• Walking
• Eating at least 1000 calories a daily
• Drinking at least one quart of fluid daily
• Free of active problems
• Without a fever
• Off intravenous medications and taking your pills without problems
• Show that you can care for your catheter

A case manager will assist with arrangements for home care. The nurse practitioner will go over your discharge and outpatient instructions and the pharmacist will review your medications with you.

Routine Outpatient Visits

Your bone marrow transplant doctor and nurse practitioner will follow you closely after your transplant. You will have blood work done and, if necessary, will be given intravenous medications or fluids.

Keeping Healthy

Your risk of infection will remain higher than normal for at least six to 12 months after allogeneic BMT even though your body is again producing white blood cells. You will be given instruction on how to help prevent infection, including washing your hands, avoiding large crowds and refraining from smoking.

Get more information about taking care of yourself after transplantation in the Outpatient Care section of the Allogeneic Transplant Guide.

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