About the Process

Once the patient has decided to proceed with the transplant, he or she should begin to put personal affairs in order so that he or she can concentrate fully on recovery. Our comprehensive manual will help blood and marrow transplant patients:

• Identify a responsible caregiver who will be with the patient for most of the time post-transplant for many weeks to provide physical care, monitor overall health and wellbeing, organize and give medications, and provide emotional support. The transplant team will educate the individual on all aspects of being a caregiver
• Arrange for housing in the area. The length of time the patient will spend in local temporary housing is typically one month for an autologous transplant and four months for an allogeneic transplant
• Plan childcare and temporary schooling for the patient’s children, if necessary
• Finalize financial arrangements

Prior to the transplant, either the donor or the patient (if the patient is his or her own donor), will be prepared for the transplant according to established protocols. In addition, it is important for the patient to attend all meetings, evaluations and paperwork in order to be fully prepared.

After the donor has been properly prepared, additional steps will be taken to complete the preparation process:

• On the first day, the transplant team conducts a patient workup, provides consent forms and reviews the transplant manual.
• On the second day, the patient meets his or her entire care team. The team is selected for their expertise based on the type of transplant the patient is having.
• Over the next seven to ten days, the patient will be thoroughly evaluated for a transplant. The comprehensive evaluation includes tests and imaging procedures.
• Following the evaluation process, the transplant oncologist will meet with the patient to discuss the results, answer questions and obtain the patient’s official consent to perform the transplant.
• The patient and his or her caregiver will attend classes and receive individual instruction on what to expect during the transplant journey.
• If the patient has a related donor, we will evaluate the donor’s health during this time. If the donor is unrelated, he or she will be evaluated at a center closer to his or her home.

When the patient and his or her donor (if the patient needs one) have been completely prepared, conditioning protocols begin. These protocols are designed to kill cancer cells, diminish the immune system to improve response to transplant, or destroy the harmful bone marrow. The patient and his or her caregiver will learn how to prevent possible infections and manage side effects. They will also give medication to help.

The transplant itself is a fairly short process. It involves infusing (injecting) cells into the patient’s body through a central venous catheter. If the patient is receiving an allogeneic transplant, one of three things will happen just before the transplant:

• The donor will undergo a process to produce more stem cells than normal and stem cells will be collected on the day of the transplant.
• The donor will undergo bone marrow harvesting on the day of the transplant
• Stem cells from cord blood will be thawed to prepare for the transplant.

If the patient is receiving an autologous transplant, his or her stem cells will have already been collected, or bone marrow will have been harvested.

Engraftment occurs when the patient’s bone marrow and immune system begin to recover thanks to the transplanted stem cells that are growing and developing. During this time, the care team will closely monitor the patient, watching for a rising white blood count that usually occurs ten to 28 days post-transplant. For a high-dose conditioning transplant, the patient will be hospitalized until engraftment occurs.

After engraftment, the patient will continue to recover as an outpatient – about three months for allogeneic transplants and about one month for autologous transplants. This is the period of time when the patient and his or her caregiver live in temporary housing. The patient will have clinic visits at least once a week where his or her blood will be drawn and other tests performed.

All post-transplant follow-up care is coordinated with the patient by the physician based on each patient’s unique needs. After returning home, BMT patients will be under the care of their referring physician.