Pre- Bone Marrow Transplant
Complete the treatment of the diagnosed blood disorder (haematological malignancy). A transplant is generally a consolidation treatment applied to ensure the disease does not reappear and so it is not usually carried out during the initial stages of treatment.
Interview with the transplant team. Once the medical team decide treatment is nearly finished, patients will be interviewed by the transplant team so they may gain a detailed understanding of the diagnosis, the treatment and the patient’s specific characteristics and those of their environment. Patients should always go accompanied to appointments.
Tests used to assess overall patient health. Patients undergo pulmonary function tests, a stress test and an echocardiogram to determine the state of the lungs and heart. A blood sample is also collected for full laboratory testing.
Stem cell extraction. Stem cells may be harvested from the actual patient or collected from a donor and frozen (cryopreservation). If the donor is someone from an international registry, then they will remain anonymous and the cells will not be stored but rather they will be administered as soon as they are extracted.
Admission to the Bone Marrow Transplant Unit. This unit has special rooms with high efficiency particulate air (HEPA) filters and positive pressure or laminar flow systems to prevent environmental fungal infections. The use of this system is very important at certain moments during the transplant.
Venous catheter placement. A catheter is a small calibre, plastic tube that is inserted near the neck or collarbone and used to deliver different treatments and collect samples for analysis.
What is a central venous catheter?
The device most typically used to infuse stem cells is a central venous catheter. It can be used to administer drugs, nutrients, blood products and other solutions directly into the blood stream. Blood samples can also be extracted using the catheter.
They are inserted into a vein in the neck (subclavian or jugular vein) and introduced until they reach a large vein close to the heart (the superior vena cava).
Patients are given a local anaesthetic and then undergo some imaging tests to confirm the catheter is positioned correctly.
Catheters can be worn for several months if they are kept in good condition. The nursing team will perform weekly care measures on the catheter to prevent any infections.
The patient will probably still wear the venous catheter when they go home after being discharged. Catheters must be kept clean and dry.
Conditioning. As part of the BMT treatment, old bone marrow must be eliminated using chemotherapy and/or radiotherapy just before administering the new cells.
This course of chemotherapy and/or radiotherapy is known as conditioning. Conditioning type, dosage and duration vary in function of the disease and the patient’s age.
Depending on the intensity of the conditioning regime, transplants are divided into two groups:
- Myeloablative conditioning (MAC). High intensity doses of chemotherapy and/or radiotherapy are used to destroy all of the patient’s bone marrow progenitor cells and so new cells must be administered during the transplant. This type of transplant is generally carried out in people aged less than 55 years.
- Reduced intensity conditioning (RIC). The dosage of chemotherapy and/or radiotherapy is attenuated which means transplants can be performed in patients aged over 55 years or who present further complications (besides the main disease) which increase the level of toxicity associated with BMTs.
Stem cell infusion. The stem cells are intravenously infused via a central venous catheter upon completing the conditioning stage. The procedure is similar to a blood infusion. Patient vital signs, e.g., blood pressure and oxygen saturation levels, must be monitored while the cells are being administered to to manage any adverse effects
Progenitor cell infusion is usually well tolerated but it can sometimes cause side effects such as chills, fever and nausea, especially if the cells have been frozen (cryopreserved).
Post- Bone Marrow Transplant
Isolation or protective measures. These may vary between transplant centres. Patients may be completely isolated for a period of 2–3 weeks until they may be allowed visitors who can enter and leave the room according to some environmental rules, e.g., the use of special masks and thorough hand washing.
Engraftment. The time it takes for the transplanted cells to become incorporated and start growing. It can vary greatly and ranges between 2–3 weeks. Patients may notice different symptoms during this period, e.g., vomiting, fever and tiredness, caused by the chemotherapy and the body’s lack of defences. These symptoms are normal and will disappear as the days pass.
Discharge from hospital. Once the levels of red and white blood cells and platelets produced by the new bone marrow have recovered and any complications that arose during the hospital stay have been resolved, patients are discharged from hospital and will continue to receive regular check-ups at a frequency determined by the type of transplant.
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