Preparing for Blood and Marrow Transplantation

During your first visit to the Blood and Marrow Transplantation Center you will meet with your physician and other members of your transplant team to begin the process of determining your eligibility for blood and marrow transplantation. Your doctor will review your medical history, perform an examination, and discuss a treatment plan with you. Blood tests and x-rays may also be necessary. 

 

The Transplant Team Eligibility Testing The Donor "To Do" List Placement of the Central Venous Catheter

A multidisciplinary health care team approach is used to provide high-quality, patient-focused care. The team is made of a variety of people who will be actively participating in your care.

• Transplant Physician (attending physician) -- the transplant physician is a doctor who specializes in bone marrow and stem cell transplantation. The transplant physician will direct your treatment plan, and will also consult with your home physician for follow-up care after you are discharged.

 
• Bone Marrow Transplant Coordinator-- The program coordinator is responsible for gathering information from the referring physician, scheduling the initial evaluations and pre-admission testing, providing information, and answering questions about blood and marrow transplantation. The program coordinator will work with your insurance company in obtaining approval for the transplant. This person will also follow your progress throughout the process.

 
• Transplant Clinical Coordinator -- The clinical coordinator is a nurse. You will meet the clinical coordinator during your tour of the transplant unit. The clinical coordinator works closely with the doctor and the nurses to plan your care. This person is also available to answer all clinical questions you or your family may have during the process. The clinical coordinator also coordinates a smooth transition from discharge to the time you are referred back to your oncologist.

• Social Worker -- Works to care for numerous issues including financial assistance, home health services, emotional and psychological support, and other things that you will need during your hospital stay and during your recovery.

 
• Clinical Manager -- The clinical manager is a nurse and is responsible for managing the inpatient nursing unit. The manager supervises the activities and the personnel on the oncology/BMT unit.

 
• Transplant Unit Nurses -- The nurses on the bone marrow transplant unit are all trained in oncology nursing. In addition, they have undergone special training to prepare them for their work with transplant patients. The nurses are responsible for your daily care such as medications, IVs, dressing changes, etc. They are also there to answer questions and provide emotional support.

 
• Epidemiology (Infectious disease) -- Because you are at high risk of developing an infection as a transplant patient, the epidemiologist carefully evaluates any signs of infection. As an inpatient, this person will review your chart on a daily basis and works closely with the pharmacist and the attending physician.

 
• Pharmacist -- The pharmacist is a resource for the doctors and nurses. He or she supervises the medication profile that you receive during the transplant process. Since one-third of your cost will be pharmacy related, these team members play an important role.

 
• Physical Therapy -- The physical therapist will evaluate your strength and normal activity pattern. They will then design an exercise program to help maintain muscle strength and flexibility.

 
• Recreational Therapy -- Recreational therapists promote wellness and quality of life. During your initial visit, the therapist will discuss leisure activities you prefer and plan an activity schedule for your hospital stay.

 
• Occupational Therapy  -- The occupational therapist works to help maintain your independence in home, work, and leisure activities.

 
• Registered Dietitian -- The dietitian works with you and your doctor to maintain good nutrition during your treatment.

 
• Home Health Nurse/Agency -- You may have home health nurses to administer growth factor injections and to care for your central venous catheter.

 
• Cancer Data Services -- These team members report findings to national and/or international organizations and assist in collaborative research efforts.

 
• Case Management -- The person works with your insurance company to review for medical necessity. The case manager also works very closely with Social Services and your physician in regard to discharge planning. If problems occur with your insurance company, this person will intervene and keep you and your family updated on the progress.

When blood and marrow transplantation is planned, additional tests are usually needed to make a final determination of your eligibility. 

Not everyone will need every test; however, some of these tests may include:

• Chest x-ray
• Pulmonary (lung) Function Test 
• Arterial Blood Gases 
• Complete Blood Count and Chemistries
• Liver Function Test 
• Creatinine Clearance (kidneys)
• MRI, CAT Scan and Bone Scan
• Electrocardiogram, echocardiogram, other studies

of the heart's structure and function
• Bone Marrow biopsy
• Dental Exam and Cleaning
• Extensive Viral Exposure Testing (HIV, Hepatitis, CMV, HSV)

The Donor

In an allogeneic transplant, a procedure in which you receive stem cells harvested from someone other than yourself, both you and the potential donor need to undergo tissue typing to evaluate the human leukocyte antigens (HLA). This test determines whether the two of you have similar or compatible antigens in the blood. If the HLA is a very close match, the donor may be considered as the stem cell donor. The closer the HLA match, the more successful the blood and marrow transplantation is likely to be. 

Since HLA is an inherited factor, parents, brothers, and sisters, are usually the first people tested. Siblings have a one in four chance of being HLA compatible or identical. If there is more than one brother or sister, the chances of finding a match increase. If no one in your family is identified as a donor, the chances are 1 in 5,000 of finding an unrelated matching donor. A donor whose HLA is not a close match to your HLA, but shares some of the factors may be considered a mismatched donor. There are nearly four million donors. By searching the NMDP list, we have access to every potential worldwide donor of blood and marrow or umbilical cord blood.

Umbilical cord blood may also be considered as a source for stem cell collection. If umbilical cord blood is going to be used, the transplant team will do a backup stem cell collection of stem cells from you or a closely matched family member . These stem cells are cryopreserved and are used only in the event that your donor cells do not begin to grow or engraft.

Once the donor has been identified, he or she will need to undergo tests to make certain the donor has no medical condition that could affect you during the transplant. If stem cells collected from umbilical cord blood are being used, both the mother and baby are thoroughly screened prior to harvesting the cells.

"To Do" List

• Housing and Care Giving After Your Transplant

It is important to have housing and care giving arrangements in place prior to entering the hospital. It will take some time to regain your strength and increase your activity level. Although the same person does not need to provide care daily, someone will need to provide 24-hour supervision, performing daily activities such as cooking and cleaning, and providing transportation.

• Packing for the Hospital

You may be in protective isolation -- a controlled environment designed to guard against infection -- during much of your hospital stay. Items from home can help make your room more cheerful and comfortable. Remember anything you bring into your protective environment will need to be cleaned with a disinfectant.

All items brought into protective isolation must be clean, some or all must be new. Check with your blood and marrow transplantation team to determine the specific requirements. 

Items that might help you feel more comfortable and pass the time in the hospital include:

• Tape player or CD
• Video games
• Handwork or craft projects (no needlepoint work) 
• Puzzles
• Cards or board games
• Journal
• Writing material
• Books or audio tape books
• Personal items like posters, pictures, and photographs
• New blankets or pillows 

You may also want to bring some of your own clothes from home to wear after you have completed the initial phase of your care.  Pajamas and robe, or comfortable loose fitting clothing, are good to include.  You may also want to bring a scarf, turban, or hat to wear. All of the clothing must be new and must be washed in a washing machine and dried on the high cycle before being brought to the hospital. Bring your clothes from home in a plastic bag to keep them as clean as possible.

Please do not bring to the hospital:

• Dried or fresh flowers
• Makeup or wigs
• Nail clippers and scissors
• Pierced earrings
• Contact lenses
• Artificial nails or nail polish
• Rings and other jewelry

Prior to your admission to the hospital, a central venous catheter will be put in place. This important line is put into a vein underneath your skin so fluids, blood products, medications, or electrolytes may be easily administered. Blood samples can also be taken from the catheter, eliminating the need for repeated needle sticks. The central venous catheter is usually positioned by an interventional radiologist in a non-surgical procedure.

Because a portion of the catheter remains outside your body, you will be instructed on how to care for the opening of the catheter and how to watch for signs of infection.

The central line stays in place until sometime after the transplant when it is no longer needed. The length of time it must remain in place varies from patient to patient.