bone marrow transplant
The bone marrow transplant procedure:
The preparations for a bone marrow transplant vary depending on the type of transplant, the disease requiring transplant, and your tolerance for certain medications. Consider the following:
•Most often, high doses of chemotherapy and/or radiation are included in the preparations. This intense therapy is required to effectively treat the malignancy and make room in the bone marrow for the new cells to grow. This therapy is often called ablative, or myeloablative, because of the effect on the bone marrow. The bone marrow produces all the blood cells in our body. Ablative therapy prevents this process of cell production and the marrow becomes empty. An empty marrow is needed to make room for the new stem cells to grow and establish a new production system.
•After the chemotherapy and/or radiation is administered, the marrow transplant is given through the central venous catheter into the bloodstream. It is not a surgical procedure to place the marrow into the bone, but is similar to receiving a blood transfusion. The stem cells find their way into the bone marrow and begin reproducing and establishing new, healthy blood cells.
•Supportive care is given to prevent and treat infections, side effects of treatments, and complications. This includes frequent blood tests, close monitoring of vital signs, strict measurement of input and output, daily weigh-ins, and providing a protected and sterile environment.
The days before transplant are counted as minus days. The day of transplant is considered day zero. Engraftment and recovery following the transplant are counted as plus days. For example, a patient may enter the hospital on day -8 for preparative regimen. The day of transplant is numbered zero. Days +1, +2, etc., will follow. There are specific events, complications, and risks associated with each day before, during, and after transplant. The days are numbered to help the patient and family understand where they are in terms of risks and discharge planning.
During infusion of bone marrow, the patient may experience the following:
After infusion, the patient may:
•spend several weeks in the hospital.
•be very susceptible to infection.
•experience excessive bleeding.
•have blood transfusions.
•be confined to a sterile environment.
•take multiple antibiotics and other medications.
•be given medication to prevent graft-versus-host disease - if the transplantation was allogeneic. The transplanted new cells (the graft), tend to attack the patient's tissues (the host), even though the donor is a relative, such as a brother, sister, or parent.
•undergo continual laboratory testing.
•experience nausea, vomiting, diarrhea, mouth sores, and extreme weakness.
•experience temporary mental confusion and emotional or psychological distress.
After leaving the hospital, the recovery process continues for several months or longer, during which time the patient cannot return to work or many previously enjoyed activities. The patient must also make frequent follow-up visits to the hospital or physician's office.