A patient admitted to the stem cell/bone marrow transplant unit will first undergo several days of chemotherapy which destroys bone marrow and cancerous cells and makes room for the new bone marrow. This is called the conditioning or preparative regimen.
The stem cells/bone marrow is infused into the patient intravenously in much the same way that any blood product is given. The transplant is not a surgical procedure. It takes place in the patient’s room, not an operating room.
Patients are checked frequently for signs of fever, chills, hives and chest pains while the bone marrow is being infused. When the transplant is completed, the days and weeks of waiting begin.
Once the donor’s cells take over the patient’s stem cells/bone marrow (“engraftment”), it is hoped that this new immune system will then fight residual cancer cells through a graft-versus-tumour effect.
The two to four weeks immediately following transplant are the most critical. The high-dose chemotherapy and/or radiation given to the patient during conditioning will have destroyed the patient’s bone marrow, crippling the body’s “immune” or defense system. As the patient waits for the transplanted bone marrow to migrate to the cavities of the large bones, set up housekeeping or “engraft,” and begin producing normal blood cells, he or she will be very susceptible to infection and excessive bleeding. Multiple antibiotics and blood transfusions will be administered to the patient to help prevent and fight infection. Transfusions of platelets will be given to prevent bleeding. Allogeneic patients will receive additional medications to prevent and control graft-versus-host disease.
Extraordinary precautions will be taken to minimize the patient’s exposure to viruses and bacteria. Visitors and hospital personnel will wash their hands with antiseptic soap and, in some cases, wear protective gowns, gloves and/or masks while in the patient’s room. Fresh fruits, vegetables, plants and cut flowers will be prohibited in the patient’s room since they often carry fungi and bacteria that pose a risk of infection. When leaving the room, the patient may wear a mask, gown and gloves as a barrier against bacteria and virus, and as a reminder to others that he or she is susceptible to infection.
Blood samples will be taken daily to determine whether or not engraftment has occurred and to monitor organ function. When the transplanted bone marrow finally engrafts and begins producing normal blood cells, the patient will gradually be taken off the antibiotics, and blood and platelet transfusions will generally no longer be required. Once the bone marrow is producing a sufficient number of healthy red blood cells, white blood cells and platelets, the patient will be discharged from the hospital, provided no other complications have developed. BMT patients typically spend four to eight weeks in the hospital.
When the donor cells approach 100%, graft-versus-host disease (GVHD) and associated infections may develop and it is, not uncommonly, life-threatening.
There is also a relatively high incidence of recurrent leukemia/cancer after transplants, particularly if the patient has residual leukemia/cancer at the time of the transplant. In this situation, it is often necessary to increase the amount of conditioning therapy given in order to prevent recurrent cancer but this results in a higher risk of organ damage.
While stem cell/bone marrow transplants do not provide 100% assurance that the disease will not recur, a transplant can increase the likelihood of a cure or at least prolong the period of disease-free survival for many patients.
A stem cell/bone marrow transplant is a physically, emotionally, and psychologically taxing procedure for the patient, family and friends. A patient needs and should seek as much help as possible to cope with the experience. “Toughing it out” on your own is not the smartest way to cope with the transplant experience.
The stem cell/bone marrow transplant is a debilitating experience. Imagine the symptoms of a severe case of the flu – nausea, vomiting, fever, diarrhea, extreme weakness. Now imagine what it’s like to cope with the symptoms not just for several days, but for several weeks. That approximates what a BMT patient experiences during hospitalization.
After being discharged from the hospital, a patient continues recovery at home for two to four months. Patients usually cannot return to full-time work for up to six months or a year after the transplant.
Though patients will be well enough to leave the hospital, their recovery will be far from over. For the first several weeks the patient may be too weak to do much more than sleep, sit up, and walk a bit around the house. Frequent visits to the hospital will be required to monitor the patient’s progress, and to administer any medications and/or blood products needed. It can take six months or more from the day of transplant before a patient is ready to fully resume normal activities.
During this period, the patient’s white blood cell counts are often too low to provide normal protection against the viruses and bacteria encountered in everyday life. Contact with the general public is therefore restricted. Often patients will wear protective masks when venturing outside the home.
It can take as long as a year for the new bone marrow to function normally. Patients are closely monitored during this time to identify any infections or complications that may develop.
Life after transplant can be both exhilarating and worrisome. On the one hand, it’s exciting to be alive after having experienced a life-threatening, life-changing situation.
Please note that the terms stem cell and bone marrow transplant are acceptably interchangeable. Nowadays, with the medical advances of bone marrow transplants, most transplants are done using the collection of stem cells rather than bone marrow harvesting. It is easier on the donor, and the procedure, process and end results is the same for the recipient. Depending on the type of leukemia, sometimes bone marrow harvests might still be required. Otherwise, most transplants are now stem cell transplants although are still generally referred to as bone marrow transplants.
Note: info taken from BC Leukemia & Bone Marrow Transplant Program and cumc.columbia.edu