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Preparing for Blood and Marrow Transplant

Knowing what to expect can make the process less intimidating. The guide below outlines the major points. In addition, your care team members can answer questions

Guide to Stem Cell Transplant

Patients will receive extensive guidance and educational materials about the specifics of transplantation, including the evaluation process, treatment side effects, a realistic timeline, lodging options, financial services and post-transplant issues. Educational materials are reviewed with the patient and caregivers for either an autologous transplant or allogeneic transplant.

The bone marrow transplant attending physician and bone marrow transplant nurse coordinator will meet with all patients on their initial transplant evaluation. After your evaluation, you will be contacted by our BMT social worker who will complete an assessment and discuss resources. Our BMT financial coordinator will contact you to discuss your health insurance benefits for transplant and any financial responsibility you may have.

In addition to a thorough physical exam and testing, patients undergo human leukocyte antigen (HLA) typing to determine the make-up of their immune system’s cells. This is necessary to ensure that their cells are compatible with a donor’s cells. If the recipient’s HLA type is different from the donor’s, the recipient’s immune system may see the new bone marrow as foreign and may attack or reject it. Or, the donor’s bone marrow may see the recipient as foreign and attack body cells.

Along with HLA typing, blood and marrow transplant patients will undergo some or all of the following tests or procedures before transplant:

  • Bone marrow aspirate & biopsy
  • Echocardiogram/EKG
  • Pulmonary function test
  • PET or CT scans or chest x-ray
  • Behavior medicine evaluation
  • Skeletal survey
  • Lab work
  • Central venous line placement (catheter placement)
  • 24-hour urine collection
  • Psychosocial evaluation

Many variables can affect the length of time a patient may wait for a transplant, including the type of transplant needed, whether a related donor has been identified or whether a non-related donor match exists. Your doctor can provide a better estimate based on your medical needs.

Central Line/Catheter Placement

Before stem cell collection for autologous transplant patients or during admission for transplant for allogeneic transplants patients, a central venous catheter will be placed as an outpatient procedure to facilitate infusion of cells, blood products (if needed) and IV medicines.

Transplantation

The transplant will be performed on an outpatient basis if approved by the insurance payer. If medically necessary, the patient will be admitted and will remain in the hospital during the transplant and recovery.

Lodging Post-Transplant

Autologous patients need to remain in the area for 30 days and allogeneic transplant patients need to stay locally for 100 days post-transplant. Patients will be referred to a local hotel for lodging. To plan for accommodation in conjunction with the transplant, please contact your social worker or Guest Services.

What to Bring

Patients should plan to bring enough comfortable clothes and shoes for two weeks, including shirts with buttons that enable easy access to the catheter. In addition, patients need to bring their own personal care items, such as shampoo, soap, a new toothbrush, electric razor, lotion and cosmetics.

Entertainment and inspirational items, including books, magazines, puzzles, games, music, music players, knitting and needlework are welcome. However, do not bring items of great value.

No flowers, pets or sick visitors are allowed in transplant rooms.

The time of the transplant procedure will vary from one to three hours (or longer) depending on the type of blood and marrow transplant. Blood and marrow transplants will be performed either inpatient or outpatient based on individual cases after the patient evaluation.

Autologous patients typically stay three to five days in Charleston for stem cell collection and then four weeks for transplant. Allogeneic transplant patients typically stay in Charleston for 100 days to receive care.

Patients will need to secure local housing based on the amount of time required to stay in Charleston for their transplant care. Our length of stay in the hospital setting is among the nation’s shortest, designed to reduce the risk of infection for the patient.

Inpatient and outpatient treatments will be combined and tailored to each patient’s needs. Post-transplant treatments can last from a week to several months.

Caregivers must be present around the clock following the patient’s discharge from the hospital. For the autologous transplant patient, a caregiver is required for 30 days. For an allogeneic transplant patient, a caregiver is required for 100 days post-transplant. Patients may rotate caregivers; however, each caregiver is required to be present for a minimum of a week at a time when not admitted to the hospital during the transplant phase to ensure consistency of care.

Following the return home, patients increase the chances of their transplant being successful by:

  • Taking new medications daily
  • Washing hands frequently
  • Avoiding sick people
  • Avoiding gardening
  • Having dedicated caregivers
  • Avoiding large crowds while taking immunosuppressive medication