The day you are admitted to the BMT/Hematologic Oncology Unit may be very busy and could produce anxiety. Hang in there! When you arrive at the hospital, report to the Registration Area; then go to the BMT unit.
When you arrive on the unit, the staff will meet you and take you to your room. Your admitting nurse will do a nursing assessment. A nurse practitioner, physician assistant or doctor will do a physical assessment. You will have a number of blood tests and if any other tests or procedures are needed, they will be done at this time. Remember, the nursing staff is always willing to answer questions or find answers for you.
If you have not yet done so, you will be asked to sign a consent form before your conditioning regimen of chemotherapy and/or radiation begins.
The conditioning regimen will vary depending on your disease, status and prior treatment. It may consist of chemotherapy alone or in combination with total body irradiation.
The chemotherapy you will receive has been carefully planned as part of a “protocol.” A protocol is a precisely timed and organized approach to the treatment of your disease outlining the medications you need. Your protocol was written by a physician and expert in the field of cancer (and blood and marrow transplantation).
Chemotherapy is an important part of your protocol. It will consist of one or more medications, depending on your disease, stage, previous treatment, age, health, etc. Your chemotherapy will given on a special schedule that is thought to be best for killing your cancer and yet reducing, as much as possible, the harm to your body’s normal cells. You will be told what days you will receive chemotherapy and how you should expect to feel. Chemotherapy drugs will be given orally or intravenously.
The doses of chemotherapy used in a transplant are much higher than those you may have received before. To rid your body of cancer cells, it is necessary to use the highest doses possible. You may experience more severe and different side effects than you have in the past.
Chemotherapy usually kills other cells in addition to cancer cells; this is why people on chemotherapy often have side effects. It can damage normal, fast-growing cells such as those in your mouth, throat, bowels, skin, hair and bone marrow. You may experience mouth or throat sores, nausea and vomiting, diarrhea, a rash, change in skin color and a loss of hair. Your blood counts may become very low.
You will receive medications to minimize nausea and vomiting. Pain medications will be given if you develop pain or sores in your mouth and/or throat. An oral hygiene program will begin once you are admitted to the hospital. Medications also will be given if you develop diarrhea or constipation.
You will lose your hair during treatment, but this is usually temporary and your hair should grow back within three to six months. Because body heat is lost through the head, you may feel colder after the loss of your hair. You are encouraged to wear a cap, scarf, wig or turban.
Chemotherapy may affect other organs of your body as well, such as your kidneys, liver, heart or lungs. Although severe side effects are infrequent, they can progress and cause complications such as veno-occlusive liver disease, kidney failure, heart palpitations or stiffening of the lungs. We cannot predict who will experience these side effects. You will be given information on these potential side effects, as well as explanations of each chemotherapeutic medication and its potential side effects.
Radiation therapy (also called irradiation) is part of some transplant conditioning regimens. The type of radiation you may receive is called total body irradiation (TBI) because it is given to your entire body. During treatment, a machine sends rays of high energy into your body. The cells in your body are prevented from growing and multiplying when they are exposed to these high-energy rays.
What to Expect
First, you will meet with the radiation oncologist, who will review the procedure and ask you to sign a separate informed consent form. TBI treatments are usually given once or twice a day – once in the morning and once in the afternoon. The number of treatments depends upon your protocol.
Before going for TBI, you may be given medication to prevent nausea. The treatment usually takes one hour. You will not feel anything while receiving the treatment. During this time, you will be asked to remain in a seated position. You will be alone in the treatment room, but you will be monitored on two TV screens by the technician. One screen will be focused on you and the other will be focused on a machine that monitors your blood pressure and pulse. If you are having any problems, you can signal your technologist, who will do everything possible to make you comfortable.
Like chemotherapy, radiation affects both cancer cells and normal cells. The side effects that may occur are due to the effects on normal cells. Initially you may experience nausea, vomiting and diarrhea. You will be given medications to prevent and treat these side effects.
After you complete the treatments, you may develop some other side effects. These may include: red, dry skin (which may begin to look like a suntan), dry mouth (which occurs from the effects of the radiation on your salivary glands), parotitis (swelling of the parotid glands in front of your ears), infertility, lung changes or cataracts. Your doctors and nurses watch very closely for any of these side effects. Some are easily treated, while others may require long-term follow-up. If you have any questions regarding your treatment, please ask any member of the transplant team or your radiation therapist.
Stem Cell Infusion
Your blood progenitor cells (BPCs) and/or bone marrow, have been stored frozen in liquid nitrogen, in special bags, since they were collected before your admission.
On the day of your autologous BMT, known as “Day 0,” your frozen stem cells will be placed in a warm water bath and thawed to body temperature. This may be done in the stem cell lab or in the BMT unit. When thawed, the BPCs and/or marrow will be brought to your room, and your doctor or nurse will return the cells to you via your long-term IV catheter, usually via an IV drip.
Your vital signs – blood pressure, heart rate, respiration, temperature, and oxygen saturation – will be monitored every 15 minutes throughout the infusion, then every 30 minutes for an hour afterward, unless otherwise indicated.
Because the transplanted cells are yours, you should not have any reaction; however, some patients have mild side effects from DMSO, the preservative used during storage. These could include nausea, vomiting, chills, changes in blood pressure, shortness of breath, flushing, or a tingling sensation. Medications are available in case of a reaction to the DMSO. These precautionary measures are standard for every BMT patient.
When your BMT has been completed, you may notice a peculiar odor that will remain for one or two days, and your urine may have an orange/red color for approximately 24 hours. These side effects are common and you should not be alarmed.
Until this time, we will have been very busy with treatments to prepare you for your autologous BMT. This day will mark the beginning of a new period, with the emphasis on supportive therapy – blood products and antibiotic therapy – until your bone marrow starts to grow and function. The support of your family and friends will be important during this waiting period.
The time required for your blood counts to increase and your bone marrow and/or BPCs to recover varies, usually it occurs within eight to 21 days. About that time, another bone marrow aspirate/biopsy may be needed to look for growth of new cells in your bone marrow.
Engraftment is the process by which the transplanted stem cells migrate from your bloodstream to the cavities of your long bones and begin producing normal blood cells. This process takes two to three weeks; during this time, you will have low blood counts and you will be susceptible to infection and bleeding. You will receive transfusions of blood products and antibiotics. Special precautions will be taken to prevent infection.
Engraftment will have occurred when your white blood count begins to rise. At this time, you will gradually be taken off antibiotics, and your need for blood and platelet transfusions will decline.