Transplant and Recovery

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.

Chemotherapy

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

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

The important day that you receive the stem cells from your donor is called Day 0. Twenty-four hours before your stem cell infusion, you will begin receiving a continuous infusion of a medication that will suppress your immune system to prevent rejection of your donor’s stem cells.

On Day 0, your donor’s stem cells will be brought to your room in a special blood product bag and administered through your long-term IV catheter by your nurse or doctor. The cells are usually given by IV drip or sometimes by IV push through a syringe.

You will be hooked up to a monitor, and your vital signs, blood pressure, heart rate, respirations, temperature and oxygen saturation will be recorded every fifteen minutes throughout the infusion, then every 30 minutes for one to two hours afterwards. Emergency drugs and oxygen will be available in the room. These precautionary measures are standard for all BMT patients. Your nurse will be observing you very closely for any side effects.

Engraftment

Engraftment is the process by which the donor’s 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.  You will receive medications to lower the likelihood of developing graft versus host disease (GVHD).

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.