Advances in the treatment of cancer and improvements in supportive care over the past 10 years have improved the results and tolerability of bone marrow transplants. However, a bone marrow transplant remains a dangerous and difficult procedure. For autologous transplantation, the patient receives his or her own bone marrow or stem cells that were collected and frozen before admission for high-dose chemotherapy or radiation.
A bone marrow transplant specialist will begin the evaluation by reviewing your medical record and history, performing a physical exam, and discussing the procedure with you. If your doctor decides that you are a candidate for an utologous bone marrow transplant, he will recommend a treatment plan.
Before being admitted to the hospital, you will have several days of laboratory and other diagnostic tests to determine if you have normal function of the heart, lungs, kidney and liver and that you do not have an undiagnosed infection. Most of these tests will be done as an outpatient before you are admitted to the hospital and others may need to be completed after you are admitted for treatment.
These Tests May Include:
- Blood tests
- Urine collection
- Bone marrow aspiration and biopsy
- Chest X-ray
- Pulmonary function tests (PFTs)
- Computerized tomography (CT scan)
- Electrocardiogram (EKG or ECG)
- Cardiac scan
- Sinus X-rays
Stem Cell Collection
Stem cells are found predominantly in the bone marrow but occasionally can be stimulated to travel out into the blood. When the stem cells are collected from the hip bone by performing many bone marrow aspirations, which are usually performed in the operating room, the transplant procedure is called a bone marrow transplant. When the stem cells are collected from the blood after stimulating the stem cells with a hormone called G-CSF, the transplant is called a peripheral blood stem cell transplant. Currently, most transplant procedures involve collecting stem cells from the peripheral blood. When bone marrow or blood stem cells are infused into the recipient, they are administered through an intravenous catheter or central venous catheter just like a blood transfusion. The stem cells are not administered directly back into the bone, but travel to the bones from the blood stream.
The collection of stem cells from the marrow is a surgical procedure in a hospital operating room, usually under general anesthesia. It involves little risk and minimal discomfort. While the patient is under anesthesia, a needle is inserted into the cavity of the rear hip bone called the iliac crest, where a large quantity of bone marrow is located. The bone marrow is a thick, red liquid which is extracted with a needle and syringe. Several skin punctures on each hip and multiple bone punctures are usually required to extract the bone marrow. There are no surgical incisions or stitches involved -- only skin punctures where the needle was inserted.
High Dose Chemotherapy
Chemotherapy begins soon after you are admitted to the hospital. Your doctor will discuss all of the drugs you will receive and their side effects. Your nurse practitioner, inpatient nurse and pharmacist also will be available to answer questions. In addition, you may receive written information on these drugs in the consent form.
Some precautions are taken to minimize side effects from these drugs. For example, when receiving some types of chemotherapy, patients must shower thoroughly twice a day to remove the drug that is excreted through the skin -- this is done to help prevent severe skin rashes. The inpatient nurse will go over any special precautions that you may need to take.
Total Body Irradiation
Some patients receive total body irradiation (TBI) in addition to chemotherapy. This radiation therapy is intended to destroy remaining cancer cells and further suppress the immune system. TBI treatments are given in the radiotherapy department usually over a period of three to four days. The treatment itself is painless, but there may be uncomfortable side effects after treatment, such as mouth and throat sores, nausea, stomach and intestinal irritations, and skin redness. Antinausea medication is usually given before each treatment to reduce nausea.
The Transplant Procedure
The transplant will occur one to three days after your last chemotherapy dose or anytime after your last radiation dose. The day of transplantation is referred to as Day 0. The days before the transplant are counted as minus days and the days after the transplant are plus days.
Delayed Side Effects
The body feels the effects of the chemotherapy or radiation about a week after transplantation. When the blood counts are low, you feel like you have the flu and may not want to do much. This will last for about two weeks and will decrease as your blood counts improve. You may notice a number of other symptoms as well, including:
- Loss of appetite
- Nausea and vomiting
- Changes in vision
- Mouth and throat soreness
- Difficulty sleeping and fatigue
- Hair loss
- Skin reactions
- Graft-versus-host disease
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