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Understanding Your Transplant

It is important for you and your family to understand what transplantation is and what it can do for you. This information will help you cope with the procedure and make the next few months a little easier. Please ask your doctor or nurse to explain anything you do not understand.

Bone marrow and blood stem cell transplantation is a treatment for many diseases in both children and adults. Among these are certain blood cancers like leukemia and lymphoma; solid tumors like breast or testicular cancer; blood diseases like aplastic anemia; and immune and genetic diseases.

Bone marrow is the spongy tissue found inside your large bones. It is responsible for making blood cells including red blood cells, white blood cells and platelets. It is also home to the immune system. All of these cells are very important, so a change in bone marrow function can be life-threatening.

In normal cancer therapy, the amount of chemotherapy given is limited because it destroys bone marrow function. Transplantation makes it possible to use higher doses of chemotherapy by replacing the destroyed bone marrow. The transplant is actually a transfusion of bone marrow stem cells or blood stem cells (collected from either a donor or the patient), which are used as a “rescue” for the patient after high doses of chemotherapy.

Stem Cell Harvesting
Blood cells grow in the same way as other human cells. They are developed in the bone marrow from a parent cell known as a “stem cell.” These stem cells begin to divide and mature until they are fully developed, forming all the different types of blood cells: white blood cells, platelets and red blood cells. Stem cells are collected so they can be given to you after high doses of chemotherapy. The process of collecting these cells is called “harvesting.” Stem cells usually are found inside the bone marrow spaces of large bones, however, they can travel from one bone to the other by way of the blood system. A very small percentage of the white blood cells circulating through your veins are stem cells. Therefore, stem cells can be harvested from either the bone marrow or the blood. Your doctor will discuss how stem cells will be collected from you or your donor.

Types of Transplantation
There are different types of transplants depending on who donates the bone marrow or blood stem cells. The most common are:

“Bone Marrow” Stem Cell Harvesting
Bone marrow stem cells are collected from either the patient or a donor depending on the type of transplant being done. The procedure is performed in the operating room. The patient/donor can be given “general anesthesia” so he or she is not awake and won’t feel anything during the procedure. The patient/ donor may also select spinal anesthesia. Once in the operating room, the patient/donor is positioned on his or her stomach. The doctors place needles into the hip bone (pelvis) and pull out the marrow with syringes. The needles are placed through the skin three to five times over each hip bone. For each puncture in the skin there are many punctures into the bone. Once collected, the marrow is filtered and placed into blood bags. If an autologous transplant is to be done, the marrow is processed and stored frozen until later. If the marrow is donated for an allogeneic transplant, it is brought to the patient for transfusion soon after the harvesting is completed. When the marrow is donated from an unrelated donor, it is collected where the donor lives and brought by courier to the patient within hours of collection.

The entire harvesting procedure takes one to two hours. The patient may receive a blood transfusion during the collection to replace the blood removed with the bone marrow. Once completed, the patient/ donor is taken to the recovery room with a large bandage across the hips that remains in place for 24 hours. Discharge from the hospital is generally the same day. There is soreness from the harvesting, but pain medication is given as needed. Soreness can vary from person to person, but normal activity is usually resumed within three to four days and complete recovery within approximately two weeks.

“Peripheral Blood” Stem Cell Harvesting (Apheresis)
Stem cells also can be collected from the circulating blood system for transplant. This method of collection is called “peripheral stem cell apheresis.” Apheresis is performed as an outpatient procedure and usually takes two to three hours per procedure. Most patients or their donors will have one to three procedures done to collect the required number of stem cells. For several days prior to the procedure, a drug called “growth factor” is taken in injection form to produce a greater number of stem cells, which are released into the blood.

Apheresis is done by inserting a needle into one arm and connect-ing attached tubing to a machine where the peripheral stem cells are separated and collected. The remaining blood components (white cells, red cells and platelets) are returned to you through a needle in your other arm. The only discomfort you may feel is when the needles are inserted. In some cases, an IV catheter is inserted in the neck or groin if the veins in the arms are not strong enough for the procedure.

You will need to report to the blood bank early in the morning for your apheresis procedure. If you are traveling a great distance, arrangements can be made for lodging by calling the bone marrow transplant social worker. Someone should accompany you to this appointment in case you need to be driven home.

Before your apheresis procedure you should:

Conditioning
Once you are ready to begin the transplant protocol, you are admitted to the hospital for high doses of chemotherapy and/or radiation therapy for what is called “conditioning.” This conditioning phase can take five to 10 days and is completed a day or two before the infusion of the stem cell product. The purpose of conditioning is to give high enough doses of chemotherapy and/or radiation to eliminate any can-cerous cells that are present, to make room for the new cells, and to destroy your immune system. This is done to prevent rejection of the new donor cells. Please refer to the transplant section for further discussion of the conditioning regimen.

Stem Cell Infusion - “Transplant”
After your conditioning chemotherapy, you are ready to receive your transplant. The infusion or “transplant” is done very much like a blood transfusion. If you are receiving stem cells from a donor (an allogeneic transplant), the infusion is given to you soon after the stem cells are collected. The “transplant” is given through your IV catheter much as other blood transfusions.

If you receive your own stem cells (an autologous transplant), a blood bank technologist will bring the frozen product to your room for thawing immediately before infusion. You may experience some side effects from DMSO, a preservative used to protect the cells while they remain frozen. You may notice a garlic-like taste in your mouth that will remain on your breath for two or three days; your urine also may become red-colored for 24 hours. The DMSO can cause other problems, such as shortness of breath, wheezing and stomach pains. These side effects occur rarely; however, your nurse and physician will monitor you closely during the transplantation.

Engraftment
Approximately two to four weeks after your transplant you can expect to see signs of your bone marrow “engrafting” or beginning to grow. The first sign of this is the production of white blood cells. Platelets often take a little longer to begin developing. Once you have “engrafted” and your condition is stable, you will be discharged from the hospital.

Discharge
Although each person varies in how long he or she takes to recover, the following are general criteria used for discharge:

• no evidence of an emerging infection or graft versus host disease
• able to tolerate oral medications, food and fluids
• active enough to function outside the hospital
• discharge teaching completed for you and your caregiver

Many patients are now being discharged earlier and followed closely in the outpatient clinic.

Refer to the section on Discharge Planning for further information.

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This site is part of the U-M Health System. The information presented is not a tool for self diagnosis or a substitute for professional care. © 2008 U-M Comprehensive Cancer Center