Patients in the UC San Diego Health and Sharp HealthCare blood and marrow transplantation program usually follow this general process, although your transplant physician will work with your physician and care team to develop the best treatment plan for you.
Initial Evaluation
Your evaluation by your BMT physician will include a review of your medical records, a physical examination, and a thorough discussion of all your non-transplant and transplant options. Because our physicians are experts in the treatment of hematologic (blood) malignancies, they understand your specific cancer and will advise you on the course of treatment that is best suited to your condition.
Are You a Candidate?
While patients up to 75 years of age may be considered for certain types of blood and marrow transplants, the following contraindications generally prohibit transplantation:
- Uncontrolled infection
- Severe non-correctable cardiac, vascular, or lung disease
- Disabling psychosis
- Significant kidney disease
- Significant liver disease
- Miscellaneous other conditions
Preparation for Transplant
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 who will discuss all aspects of the procedure and follow-up care with you and your family. Education continues and is reinforced by inpatient nurses once you are admitted to the hospital.
We also offer
educational classes and support groups for patients and their families.
Transplant Procedure and Hospital Stay
Though some patients may be able to receive care on an outpatient basis, most patients will require inpatient care. At present, the average hospital stay for BMT patients is three to four weeks. The transplant procedure can be broken down into three major phases:
Pre-transplant high-dose chemotherapy (conditioning phase)
Patients are treated with one of several regimens using chemotherapy alone, or chemotherapy with total body irradiation. This preconditioning is necessary so that the patient can accept transplanted cells, and it allows the highest success by eradicating the malignant cells.
Infusion of hematopoetic stem cells
The actual transplant is a fairly simple procedure. The stem cells are infused through a central venous catheter, similar to a blood transfusion. The new stem cells gradually move to the bone marrow space and start to develop new marrow. This process is called "engraftment" or marrow recovery, and usually begins to occur between 10 to 21 days after the transplantation.
In the case of autologous stem cell transplantation, a preservative is added to the cells, which may cause the patient to experience an unusual taste and odor. Patients receiving allogeneic stem cell transplantation may experience a chill or fever after the procedure.
After the BMT procedure
Following your BMT, you’ll stay in the hospital for three to four weeks. In addition, you’ll need to follow a drug therapy regimen that may involve:
- Anti-emetics: Patients may continue on anti-emetic therapy for several days following their transplant until appetite stabilizes.
- Immunosuppressives: For patients of the allogeneic stem cell transplant procedure, cyclosporine or FK506 is most commonly prescribed. Patients may be placed on Prednisone or Solumederol if "graft vs. host disease" (GVHD) develops.
- Antibiotics: Since patients are at risk for developing a significant blood-borne infection, most patients are placed on prophylactic antibiotics. A special diet for neutropenic patients and other precautions to reduce risk of infection will be followed.
Your physician will discuss your follow-up treatment options with you.
Going Home
Upon discharge, you will come in for follow up 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, or longer if necessary. For patients 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 levels of energy and activity approximately six to eight weeks post-transplant. Allogeneic transplant recipients may require several months to return to normal activity levels.
Specific instructions are given to each patient on how to avoid infection and follow a post-transplant diet.
Survivorship Program
BMT can lead to side effects, including some that can occur years after transplant. Because of this, we closely monitor our patients through our
Survivorship Program.