Bone Marrow Transplant

A bone marrow transplant may be needed if:

1. Your bone marrow is defective, containing either cancer cells or other abnormal types of blood cells (example – sickle cells)
2. Your bone marrow is not strong enough to survive the effects of high dose chemotherapy. For example, patients with tumors often require high doses of chemotherapy to kill their tumor cells. This chemotherapy may also be strong enough to destroy your blood and bone marrow cells. In this case, the bone marrow transplant is given as a rescue, to allow new bone marrow and blood cells to grow.

In order to undergo a transplant, we must obtain stem cells from a donor. The process of collecting these cells is called harvesting. There are two basic ways to harvest or collect stem cells:
•    Bone marrow harvest: The stem cells are collected directly from the hip bone of a donor.
•    Blood stem cell harvest: The stem cells are collected directly from the blood (veins) of a donor.

The transplant team includes the following professionals:
•    Doctors
•    Pre-Transplant Nurse Coordinators
•    Inpatient Nurses
•    BMT Clinic Nurses
•    Nurse Practitioners and Physician Assistants
•    Dietitians
•    Clinical Pharmacists
•    Blood Bank Technologists
•    Physical/Occupational Therapists

Following are the steps:
•    Initial Consultation
•    Disease Status Evaluation
•    Organ Function Evaluation
•    Consultations
•    Caregiver Plan
•    Stem cell Mobilization and Collection Procedure
•    Admit for transplant

Following are the steps:
•    Initial Consultation
•    Search for Donor
•    Disease Status Evaluation
•    Organ Function Evaluation
•    Consultations
•    Caregiver Plan
•    IV Catheter Placed
•    Final Tests
•    Admit for Transplant

Patient must take care of:

• Nutrition- The transplant dietician will help you meet your nutrient requirements by offering nutritional supplements or by suggesting nutritious foods that you can tolerate
• Mouth Care- Good oral hygiene will be important to you before, during, and after your transplant. Mouth sores and infections can be painful and life threatening. This is an area where you can make a difference.
• Hygiene- It is necessary for you to take a shower every day. Your nurse will provide you with a special antimicrobial soap to use that will kill bacteria on your skin. Always remember to wash your hands before and after using the bathroom, touching sores on your body, and performing mouth care.

Discharge is available for patients if they fulfil: 
•    Stable vital signs and no fevers for 24 hours
•    Infections and graft versus host disease (GVHD) should be absent, stable, or under control
•    Not requiring daily transfusions (especially platelet transfusions)
•    Able to tolerate oral medications, food, and fluids
•    Active enough to function outside the hospital
•    Nausea, vomiting, diarrhea under control

•    Infections: During and after your transplant, you will be at risk for developing many different types of infections. Immediately after your transplant you are at risk for bacterial and fungal infections, as well as for reactivation of certain viruses that reside in your body (for example, the chicken pox or herpes simplex virus). During the first several months after your transplant you will continue to be susceptible to infections, especially viral infections.
•    Veno-Occlusive Disease (VOD): This is a complication that typically affects the liver. It is caused by the high doses of chemotherapy that may be used during the transplant. When VOD occurs, it becomes very difficult for the liver and subsequently lungs and kidneys to function normally. The signs and symptoms of VOD may include jaundice (yellow skin and eyes), a swollen and tender belly (especially where your liver is located), and weight gain. Treatment for VOD may include various medications, blood transfusions, careful monitoring of your liver and kidney function, and blood tests.
•    Lung and Heart Complications: Pneumonias are common following transplant. Approximately 30-40% of patients undergoing an allogeneic transplant and approximately 25% of patients undergoing an autologous transplant will develop pneumonia at some point during their transplant course. The pneumonia may be severe, even life threatening in some cases. Not all pneumonias are caused by infections.

•    Bleeding: Bleeding after transplant is common, especially when your platelet levels are very low. Platelet transfusions are given to try to prevent severe bleeding. Your platelet count and signs of bleeding will be monitored often by your medical team during your transplant. Blood in the urine (called hematuria) is also common after certain types of transplant, and is often due to a specific virus that infects your bladder

•    Graft Versus Host Disease: Graft versus host disease (GVHD) is a complication that occurs when the new stem cells (the graft) react against your body (the host). It can range from a very mild complication or may progress to a life-threatening one.

Many of these precautions and restrictions are necessary to prevent infections and bleeding. Your bone marrow needs time to mature before it is considered fully recovered. Until that time, there are things you should watch for and help prevent. These restrictions will lessen over time, as your bone marrow and immune system become fully functioning.
•    Masks: A mask is not necessary when you are at home or out for a walk but is required if visiting in polluted conditions.
•    People: Avoid close contact with anyone who is ill. Avoid crowded areas, especially during cold and flu season. Stay away from anyone exposed to communicable and/or childhood disease.
•    Pets and Animals: Household pets can remain in the home, except for birds and reptiles. Avoid all contact with birds or reptiles and their droppings; they carry many infections. Avoid contacting animal waste.
•    Plants and Flowers: These can remain in the home. Avoid gardening, mowing the lawn and other activities that stir up soil or the ground. Avoid handling fresh-cut flowers in vases; the water can carry large amounts of bacteria.
•    Travel: Notify your doctor before you travel. In general, you should avoid swimming in lakes, public pools and sitting in hot tubs due to the possibility of exposure to excessive bacteria.
•    Physical Activity: It is essential to maintain the activity program outlined in the hospital by your physical therapist. There is a potential for developing infections in your lungs after the transplant, and remaining active helps keep your lungs stronger.
•    Driving: You will not be able to drive for at least three months following your transplant. This period may be shorter for patients receiving their own stem cells. Physical stamina is generally reduced and could lead to a decrease in the reflex time necessary for safe driving.
•    Returning to Work or School: Your return to work or school will depend on the type of transplant you receive and how your recovery proceeds. For the first 100 days after your transplant you will not return to work or school.
•    Reimmunizations: Since your immune system is so intensely affected by the transplant, it may no longer remember its previous exposures to childhood vaccinations. Therefore, you will be reimmunized with several of your “baby shots” one to two years after transplant.
•    Diet: Loss of taste and appetite happens frequently following transplant. If you are having problems eating a diet adequate in calories and protein, talk with our dietitian.

It is okay to eat raw fruits and vegetables after you are discharged from the hospital. These foods should be cleaned thoroughly under running water and bruises or bad spots should be removed. Fruits and vegetables that cannot be cleaned well should not be eaten raw.

Pepper and other dried herbs may be added to foods that are going to be baked or heated to a steaming temperature in the microwave. You should not add pepper to foods that have already been heated or will be eaten raw.

It is okay to eat food that is hot, freshly prepared and fully cooked. Uncooked or stir-fried fruits, vegetables, and salads should be avoided. Avoid salad bars, smorgasbords, and potlucks. Ask that food be prepared fresh, and order food without toppings or condiments (lettuce, tomato, mayonnaise). Meats and fish must be cooked thoroughly. Do not eat raw seafood including oysters, sushi, sashimi, lightly steamed seafood like mussels, clams, and snails.

You may have lost some muscle mass during your hospitalization. Eating enough protein is important to restore lean body mass and avoid fluid retention. Try eating more of these foods: beef, poultry, fish, cheese, eggs, dairy products, peanut butter, and beans. If you do not have an appetite for these foods following transplant, ask your Registered Dietitian for some high protein drink recipes