Successful blood and marrow transplantation requires healthy blood and/or bone marrow for infusion. In addition, you must be healthy enough to endure the rigors of the BMT process. To determine whether you are a good candidate, your doctor will consider your age, general physical condition, diagnosis and stage of disease.
One very common and realistic concern is how to deal with the extended period of hospitalization.
The average period of hospitalization for allogeneic BMT patients is from three to six weeks. Your stay at RPCI will depend upon your specific needs. Preparing for such a lengthy hospital stay can be extremely difficult. You will have to decide which priorities you should address. Remember, the minimum hospital stay could change because timing depends on recovery of the blood or bone marrow, complications that may arise and many other factors. Make preparations for a longer stay than anticipated. That way, you won’t be discouraged by an extended stay, but could find yourself uplifted by the pleasant surprise of an earlier than expected discharge.
Although still extremely challenging, undergoing a BMT today is not quite as difficult as in the past. This is due to advances in medical technology, better supportive care, new medications, less intense regimens, shortened hospital stays and the ability to give medications in the outpatient setting. Our chemotherapy and radiation regimens have been refined to be as beneficial as possible for our patients, with the least possible toxicity (side effects).
During your first visit to RPCI, a complete medical history will be taken. This will include confirmation of your diagnosis, a detailed description of your previous treatments, the results of those treatments and your reactions to them. Any other existing medical problems will be evaluated, including any history of allergies and infectious diseases. You will be required to provide your initial slides to confirm your diagnosis, and any test results (such as x-ray films or CAT scan results) that will help determine the status of your disease. You may require additional courses of chemotherapy and/or radiation before being considered for a BMT.
Before the transplant process begins, we must ensure that your heart, lungs, kidneys and liver are strong enough to tolerate the side effects of chemotherapy and other medications that may be used during the procedure. Before the transplant, you will have a series of outpatient tests to determine your current state of health. These tests must be completed within 30 days prior to your admission for transplant. Listed below are the possible tests you may undergo, depending on your disease, your transplant protocol, and whether you have had these tests previously.
- Chest x-ray – Checks your lungs for disease.
- Bone marrow aspiration and biopsy – Checks your bone marrow for disease and genetic information.
- Lumbar puncture – Checks the fluid surrounding your brain and spinal cord for disease or infection.
- Blood tests – Checks your blood counts, as well as liver, kidney, and immune system function; also checks for infectious diseases.
- CAT scan/skeletal survey – Special x-rays look at your neck, chest, abdomen, head or bones to monitor for disease.
- Pulmonary function test – Determines how well your lungs are working.
- ECHO/EKG/MUGA – These three tests determine how well your heart is working.
Long-term Intravenous Catheter Placement
Before your transplant, you will be given a long-term intravenous (IV) catheter, if you do not already have one. This IV is a special catheter inserted by a doctor into a large vein in your chest so that you do not have to endure repeated needle sticks. You will be given a sedative and local anesthesia to numb the area.
The catheter is made of plastic and is similar to regular IV tubing. It has several ports, allowing it to be used for taking blood samples and giving chemotherapy, antibiotics, blood products and other medications. The catheter will remain in place for the duration of your transplant and for as long as needed after discharge.
You and/or a family member will receive instructions on how to care for and clean the catheter.