What to Expect During the Transplant Process

Initial Consult

The initial consult will help you decide if BMT is right for your child. You will meet with one of our BMT physicians and learn how the transplantation is performed and its potential risks and benefits.

Patients proceeding to transplant work closely with our transplant coordinators to make the necessary preparations for transplant.

For patients receiving an allogeneic transplant (bone marrow cells from another person), this will include tissue typing and identification of a donor. This could be a family donor, an unrelated donor or cord blood unit identified through the transplant registry. If the patient will be receiving their own cells, this will involve collection of blood stem cells.

Pre-Transplant Evaluation

The pre-transplant evaluation happens closer to transplantation and includes blood work and testing of the function of the heart, lungs, and other organs to make sure they are ready for BMT.

Patients will meet again with their transplant physician and other members of our team, including one of our nurse practitioners, our nurses, our social worker, and our transplant infectious disease specialist. Some patients will also meet with our radiation oncology team (if your treatment involves radiation) and our fertility preservation team.

Our nurses meet with families prior to admission to help them prepare for the admission. The nurses, doctors, and other team members focus on easing the emotional and physical burden of the admission.

Transplant Admission

Patients are admitted to our Golisano Children’s Hospital’s Hematology-Oncology/Blood and Marrow Transplant Unit (7 North). The unit is specially equipped with an air filtration system to prevent infection in patients with low white blood cell counts. Patients are cared for by nurses that are specially trained in BMT. Many precautions are taken to protect patients from infection.

Length of Stay

• Patients receiving an autologous transplant (getting their own blood stem cells) usually spend about three to four weeks in the hospital, sometimes longer.
• Patients receiving an allogeneic transplant are usually in the hospital for four to six weeks, sometimes longer.

Conditioning Regimen

• The conditioning regimen is the treatment used to prepare a patient to receive the transplant. It includes chemotherapy and other medicines that eliminate the patient’s bone marrow cells and weakens the immune system. The conditioning regimen may also include radiation. 
• For patients with leukemia or other cancers, the conditioning regimen is used eliminate cancer cells.
• The length of the conditioning regimen varies depending on a patient’s disease and the type of transplant she or he is receiving. It can be as short as two days or as long as 10 days or more. During this time, patients receive medicines to prevent nausea and vomiting and other possible side effects of the conditioning regimen.

The Transplant

After completing the conditioning part of the transplant, patients receive their transplant.

The cells are administered by IV infusion, much like blood cells are transfused. The infusion is usually short (less than an hour) for patients getting an autologous transplant. For patients getting an allogeneic transplant, it may last several hours.

After Transplant

The hardest part of the transplant for most patients starts after the cells are infused. In the days that follow, blood counts fall and patients need blood and platelet transfusions. Patients receive antibiotics to prevent and, sometimes, treat infections. Some patients may need care for other problems, like mouth sores, during this time. If a patient receives an allogeneic transplant, they will receive medicines to suppress the donor cells and prevent a condition called graft versus host disease.

As the patient’s blood counts recover, patients typically recover from other problems, like mouth sores, and patients get ready to leave the hospital. Sometime patients need to stay in the hospital longer to receive treatment complications of the transplant.

Post-Transplant Care - Autologous Transplant

Following discharge from the hospital, patients typically feel well. Patients who receive an autologous transplant typically need post-transplant care for two to three weeks. If these patients are referred from another medical center, this care is usually delivered by their home team. This way they can return home.

Post-Transplant Care - Allogeneic Transplant

Patients who receive allogeneic transplants require prolonged post-transplant care.

• If these patients are from the Rochester region, they usually return home when discharged.
• If patients are from outside the Rochester region, we recommend they remain in Rochester for a minimum of two weeks as their early post-transplant care can be complicated, and sometimes they need to be readmitted for treatment of transplant complications. For patients needing to stay in Rochester post-transplant, our social worker will arrange for local accommodations.

Most patients receiving an allogeneic transplant need to be seen as an outpatient two to three times a week initially. These early post-transplant visits will involve laboratory testing and may involve blood transfusions and medication infusions.

Post-transplant care also involves monitoring the percentage of donor cells in the patient’s blood. And, if a patient received their transplant for leukemia, bone marrow evaluations (and sometimes other evaluations) are performed periodically.

For patients referred from another medical center who are ready to return home, we usually arrange to share care with hematologist-oncologists at the referring center, with patients alternating visits between the two sites.

As patients get further out from their transplants, the frequency of outpatient visits decreases. By six months post-transplant many patients can be seen monthly. Eventually, patient care is transferred fully back to the referring center.

Risks of Infection

An important thing to appreciate about allogeneic transplants, is that the transplant weakens the immune system greatly. Usually, the immune function improves with each passing month, but during the initial months after transplant, patients are very susceptible to infections, especially viral infections from other people. Because of this, the patient and family need to take precautions to avoid exposure to sick people. This includes not attending school in person and not going back to work physically.

Another important thing to note about allogeneic bone marrow transplants is that most patients can safely discontinue their immune suppression medications before they are a year post-transplant. Some patients, though, require immune suppression for longer, usually to treat graft versus host disease (a condition that results when the donor cells react against the patient’s body).