Your Guide to the Transplant Process
Every transplant involves several important steps, and Wilmot’s experts are by your side throughout the entire process to guide you.
Initial Consultation
At your first appointment, you and your family will meet with one of our physicians and a nurse coordinator to learn more about the transplant process. The initial consultation takes about two hours. During your appointment, your physician will discuss:
- Your type of disease
- Available treatment options
- Your medical history
- Psychosocial issues: family support and religious beliefs
- Donor source, including how stem cells will be collected
- Timing of BMT and the need for chemotherapy so the disease is in a minimum state or remission
- Financial concerns and insurance coverage
- Blood tests to determine previous infections
All new patients proceeding to transplant will also have an appointment scheduled with our outpatient social worker, which will occur after the provider consultation.
Evaluation and Pre-Testing
If you are a candidate for a transplant, your team will continue your evaluation to determine the best treatment options for you.
Your team will arrange a series of medical tests to learn more about the state of your disease and organ functions. Tests may include:
- Blood tests
- Bone marrow biopsy
- Lumbar puncture
- CT scans/MRI scans/PET scans
- Dental exam
- Echocardiogram or MUGA (multiple-gated acquisition) scan
- EKG
- Pulmonary function test
- Urinalysis
- X-rays
- Psychological evaluation
Blood Tests for Allogeneic Transplants
If you may be receiving bone marrow from an allogeneic donor, you will have a blood sample and cheek swab taken to determine if you are compatible with the donor. The blood test checks whether you and the donor have any matching Human Leukocyte Antigens (HLA).
Only identical twins have identical HLA types, but siblings may be matched for major HLA, making them suitable donors.
Hematopoietic Stem Cell Collection
For autologous transplants, stem cells are collected from the bone marrow of the patient. For allogeneic transplants, the stem cells are collected from a donor.
The cells are collected from the patient or the donor using a process called apheresis, in which blood is drawn from a vein through a catheter tube, the stem cells are removed and stored, and the rest of the blood is returned to the patient or donor through a catheter tube in a vein.
For autologous transplants, the stem cells will be frozen and stored until needed. For allogeneic transplants, the stem cells are given as soon as possible after they are collected.
Conditioning Therapy
One to seven days before the transplant, you will undergo chemotherapy with or without radiation to destroy the cancer cells. Conditioning chemotherapy is given in the Wilmot Cancer Center Infusion Center or inpatient unit by specially trained BMT nurses, so our care team can monitor any side effects, infection, and response to treatment. You will be admitted to the inpatient unit on or before the day of stem cell infusion.
Infusion
During infusion, the healthy stem cells are added to your bloodstream through a central intravenous catheter in the chest. The infusion will happen in your inpatient hospital room. Most patients are awake, but they may have light sedation. Typically, the process lasts from 30 minutes to an hour, depending on the volume of cells. During and after the infusion, our team monitors you for any side effects from the treatment.
Engraftment
When the healthy stem cells enter the bloodstream, they travel to the bone marrow, where they begin to produce new white blood cells, red blood cells, and platelets in a process known as engraftment. The process may take several days to weeks.
During this time, you will continue to be treated by your care team in our center, receiving:
- Antibiotics to prevent infection
- Blood transfusions of red blood cells and platelets to prevent bleeding
- Medication to prevent post-transplant diseases, such as infection or graft-versus-host disease (GVHD)
- Daily blood tests to determine if the stem cells have engrafted
- Frequent monitoring of vital signs
Recovery
Recovery can be a lengthy process of healing after the transplant, but your care team will be ready to help you through it. During this time, you will regain blood cell production and immune function, as well as strength and energy. You will be scheduled for frequent follow-up appointments and lab tests during the recovery process.
It is important that you drink plenty of fluids and eat nutritious, well-balanced meals after your transplant.
Some patients feel depressed after a transplant and may find counseling helpful during this time. We welcome you to discuss any concerns with a member of your care team.
After discharge, patients and their families can call the transplant team with any questions or concerns, but especially if the patient is experiencing:
- Fever or uncontrolled shaking
- Catheter tenderness, redness, swelling, discharge, or difficulty flushing
- Bleeding
- Rash or yellow skin tone (jaundice)
- More than two bouts of diarrhea in one day
- Persistent headache, vision changes, muscle weakness, worsening fatigue, worsening hand tremors
- Poor food or fluid intake, persistent nausea, and vomiting
- Exposure to communicable diseases, such as chicken pox
For Allogeneic Patients
Allogeneic patients will take several medications to control for the possibility of graft-versus-host disease (GVHD), infection, and electrolyte imbalance.
GVHD sometimes occurs after a transplant. The donor’s immune cells in the transplanted marrow attack various organs such as skin, liver, and GI tract.
To treat GVHD, the patient takes high-dose corticosteroids and possibly other treatments to suppress the immune response without damaging the new marrow.