Hyundai Cancer Institute :: The Blood or Marrow Transplant Process Frequently Asked Questions
The information below is provided by the CHOC Children's Blood and Marrow Transplant team. It is important to address specific questions and concerns about the transplant process with the patient's case coordinator or physician.
How does a blood or marrow transplant recipient prepare for the transplant procedure?
For the child receiving the transplant, the following will occur in advance of the procedure:
- Prior to the transplant, an extensive evaluation is completed by the Blood and Marrow Transplant (BMT) team. All other treatment options are discussed and evaluated for risk-versus-benefit.
- A complete medical history and physical examination are performed, including multiple tests to evaluate the child's blood and organ functions (i.e., heart, kidney, liver, lungs).
- A child will often come to the CHOC BMT center seven to 14 days prior to transplant for hydration, evaluation, placement of a catheter (also called a "central venous line") and other preparations. The central venous line is surgically placed in a vein in the chest area. Blood products and medications will be administered through the catheter.
- A suitable (tissue-typed and matched) donor must be available.
What is the procedure like for the recipient?
The preparations for a transplant vary depending on the type of transplant, the disease requiring transplant and the child's tolerance for certain medications.
- Most often, high doses of chemotherapy and/or radiation are included in the preparations. This intense therapy is required to effectively treat the malignancy and make room in the bone marrow for the new cells to grow.
- After the chemotherapy and/or radiation is administered, the transplant, either from bone marrow, cord or from peripherally collected stem cells, is given through the central venous catheter into the bloodstream. It is not a surgical procedure to place the marrow into the bone, but is similar to receiving a blood transfusion. The stem cells find their way into the bone marrow and begin reproducing and establishing new, healthy blood cells.
- Supportive care is given to prevent and treat infections, side effects of treatments, and complications. This includes frequent blood tests, close monitoring of vital signs, strict measurement of input and output, weighing the child daily (or twice daily), and providing a protected and sterile environment.
The days before transplant are counted as minus days. The day of transplant is considered day 0. Engraftment and recovery following the transplant are counted as plus days. For example, a child may enter the hospital on day -8 for preparative regimen. Days +1, +2, etc., will follow. There are specific events, complications, and risks associated with each day before, during, and after transplant. The days are numbered to help the child and family understand where they are in terms of risks and discharge planning. Depending on the type of transplant and the disease being treated, engraftment usually occurs around day +15 or +30.
During infusion of bone marrow, the child may experience some or all of the following symptoms:
- nausea / vomiting
- chest pain
After infusion, the child may:
- spend several weeks in the hospital.
- be very susceptible to infection.
- experience excessive bleeding.
- have blood transfusions.
- be confined to an environment that will prevent them from being infected from sick people.
- take multiple antibiotics and other medications.
- be given medication to prevent graft-versus-host disease (if the transplant was allogeneic). The transplanted new cells (the graft) tend to attack the child's tissues (the host), even if the donor is a relative, such as a brother, sister, or parent.
- undergo continual laboratory testing.
- experience nausea, vomiting, diarrhea, mouth sores and extreme weakness.
- experience temporary emotional or psychological distress.
When will my child be discharged?
One should expect a prolonged hospitalization for BMT admission, which could be at least four weeks or a few months. Hospital discharge following a transplant depends on many factors, including the following:
- extent of engraftment,
- presence of complications,
- the patient’s overall health, and
- suitable living arrangement must be available within a 50 mile radius from the hospital.
Frequent visits to the child's transplant team will be required after discharge to determine effectiveness of treatment, detect complications, detect recurrent disease and to manage the late effects associated with a transplant. The frequency and duration of visits will be determined by the patient’s transplant team. Initially, clinic visits are one to two times per week and as the child recovers, it spreads out to weekly or every other week and so on.
How do bone marrow transplant donors prepare for the donation procedure?
Donor sources available include: self, sibling, parent or relative, non-related person, or umbilical cord blood from a related or non-related person. There are national and international registries for non-related persons and cord blood. For family members, they may elect to have their blood typed to check for bone marrow compatibility because of the desire to help. This testing is called HLA (Human Leukocyte Antigen) typing. These relatives may choose to have their HLA typing results registered for use for other recipients in need of a donor.
If the potential donor is notified that they may be a match for a child needing a transplant, they will undergo additional tests. Tests related to their health, exposure to viruses and a complete genetic analysis will be done to determine the extent of the match. The donor will be given instructions on how the donation will be made.
Once a donor for a child needing a transplant is found, then stem cells will be collected either by a bone marrow harvest (collection of stem cells with a needle placed into the soft center of the bone marrow) or peripheral blood stem cell collection or “apheresis” (stem cells that are collected from the circulating cells in the blood).
A bone marrow harvest is performed under general anesthesia by two physicians. The procedure generally takes approximately an hour and the donor is usually released the same day, after a few hours, after recovery. A slight discomfort to the pelvic bone areas and fatigue is usually experienced after the procedure, but subsides within a few days and donors can return to normal activities at this time.
A peripheral blood stem cell collection or “apheresis” procedure takes approximately four to six hours. A peripheral IV or central line is placed into a large vein and the stem cells are collected. The donor should be released the same day after the procedure. A slight discomfort to the line insertion areas and fatigue is usually experienced after the procedure. The donor can return to work when their fatigue subsides a few days after the donation.