What to Expect
At UC San Diego Health, patients usually follow the process outlined below. Your care plan may be different, depending on your needs for blood and bone marrow transplantation.
Your First Appointment
At your initial evaluation, your physician will review your medical records, perform a physical exam and thoroughly discuss all your care options.
Preparing for Your Blood or Marrow Transplant (BMT)
If you and your doctor elect to have a blood or marrow transplant, you will meet with a BMT social worker and a BMT coordinator to discuss all aspects of the procedure and follow-up care. Education continues and is reinforced by inpatient nurses once you are admitted to the hospital.
We also offer treatment educational classes for patients and their families.
Your BMT procedure will generally follow the steps below and may be modified depending on your condition.
Pre-Transplant High-Dose Chemotherapy
You're treated with one of several regimens using chemotherapy alone, or chemotherapy with total body irradiation. This preconditioning helps the body accept transplanted cells, and it allows the highest success by eradicating malignant cells.
Infusion of Stem Cells
Stem cells are infused through a central venous catheter, similar to a blood transfusion. The new stem cells gradually move to the bone marrow and start to develop new marrow. This process is called "engraftment" or marrow recovery. It usually begins between 10 to 21 days after the transplantation.
When you have an autologous stem cell transplantation, a preservative is added to the cells, which may cause you to experience an unusual taste and odor. You may also experience a chill or fever after the procedure.
After your BMT, you’ll stay in the hospital for three to four weeks and will need to follow a drug therapy regimen that may involve:
- Anti-emetics until your appetite stabilizes
- Immunosuppressives, including cyclosporine or FK506 if you've had an allogeneic stem cell transplant
- Antibiotics to prevent infection. You will also likely be placed on a special diet to further reduce your risk of infection.
After discharge from the hospital, you will come in for follow-up visits twice a week. Autologous transplant recipients are followed for about 30 days before returning to their referring physician. Allogeneic transplant recipients are followed for at least the first 100 days. For those who received a non-related donor transplant, the period of intensive follow-up may last six months to a year.
Most autologous transplant patients begin to return to normal energy levels and activity about six to eight weeks after their BMT. Allogeneic transplant recipients may require several months to return to normal activity levels.
You will be given specific instructions on how to avoid infection and follow a post-transplant diet.
Life After BMT
To help our BMT patients enjoy the best health possible, UC San Diego Health offers a unique BMT Survivorship Program for our allogeneic patients. Allogeneic transplant patients may be at risk for graft-versus-host disease (GVHD) and have a higher risk for other complications. Our program aims to identify those who should be closely monitored and aggressively treated to prevent complications.
Your first visit is usually a one-hour visit with a physician or nurse practitioner. Visits begin about a year after your transplant and continue annually. Your provider may:
- Discuss your recent medical history and cancer treatment effects
- Screen you for cardiovascular risk factors, thyroid issues, diabetes risk factors, bone health, and kidney and liver function
- Discuss lifestyle issues, including sun protection, exercise and nutrition
- Evaluate you to detect a recurrence of cancer or the appearance of secondary cancers that can be more common among BMT patients
- Recommend a social worker for emotional or social challenges
- Provide a treatment summary and follow-up plan
If any follow-up treatment is necessary, we can coordinate with your primary physician and medical oncologist.
A support group can help you with the difficulties and stresses of post-transplant life. We offer a quarterly support group with a different discussion topic each meeting to help survivors and their families adjust to life after treatment and learn about available services. If you are interested in receiving e-mails about our transplant survivorship group meetings, call 858-822-6600 for more information.