The Transplant Process
The process for getting a bone marrow transplant is a long one, from early planning all the way through long-term follow-up care. This page provides an overview of the main steps.
When you come to Seattle Cancer Care Alliance (SCCA) for a transplant, your healthcare team will discuss your individual treatment plan with you and your family and answer all your questions before your treatment begins. You’ll get a guide called “Preparing for Transplant” and a “Patient & Caregiver Resource Manual.” SCCA also offers classes each week to help patients and caregivers prepare for transplant and recovery. Once you’ve begun treatment, your transplant care coordinator and Transition Services team will guide you through the process.
For many patients, the process begins with an initial consultation, which takes place at the SCCA clinic, to discuss the possibility of a transplant. At your consultation:
- You will meet with a transplant oncologist who has expertise with your disease. This doctor will review your medical records, talk with you about your treatment options and make recommendations for you and your referring doctor.
- A transplant nurse will offer you an orientation and tour.
- You will meet with a representative from Patient Financial Services to talk about treatment costs, your insurance coverage and how to pay for your transplant.
- We will give you a packet of transplant information to take home.
To schedule a consultation, call (800) 804-8824. If you are from outside the area and you are not sure you can travel here for a consultation, please call us to talk about options.
Once you decide to have a transplant, you will begin the seven steps listed below.
You’ll want to organize your personal affairs and put plans in place to ease the transplant process so you can give your full attention to your recovery. We’ll send you a book and DVD called “Preparing for Transplant” to help guide you on important matters such as:
- Selecting a caregiver, a responsible family member or friend to provide physical care, help monitor your health, administer medications and give you emotional support. Your transplant team will teach your caregiver about these duties.
- Arranging to live in Seattle for your transplant, if you don’t live here already. The length of time is different for each patient and depends on your disease, individual treatment plan and response to treatment. Your transplant team can talk with you about the length of time you can expect. A typical range is from one to four months.
- Bringing your children with you, and arranging for school and childcare.
- Making financial arrangements to pay for your transplant and your living expenses during your time in Seattle, or raising funds to help
Two main elements to preparing for a transplant are readying the donor (whether that’s someone else or you) and arriving at SCCA for the meetings, evaluations and paperwork that need to happen right before your transplant occurs.
Readying the Donor
- Allogeneic: If you will have an allogeneic transplant (using someone else’s cells), the preparation step includes identifying a donor. If you have one or more relatives who are available to donate, this is when they will be tested to see if any is a close-enough match for you according to HLA type. (Some patients receive a transplant using cells from a donor who is only a half-match, called haploidentical.) If you do not have a related donor, we will search internationally for an unrelated donor using donor registries.
- Autologous: If you will have an autologous transplant (using your own cells), you are the donor.
- For a transplant using peripheral blood stem cells (PBSCs): Before you arrive at SCCA, your preparation will include stem cell mobilization (receiving medicine that causes stem cells to leave the tissues they normally occupy and to circulate in the blood stream). After you arrive at SCCA, we will collect your PBSCs.
- For a transplant using bone marrow: You do not need any special preparation. We will harvest your bone marrow after you arrive at SCCA.
Arriving at SCCA
Once your donor (or you, for an autologous transplant) has been prepared, you will come to SCCA.
- First visit: First, you will meet with your doctor and nurse to discuss your health history, have a physical exam and blood draw, get a tour of the transplant clinic, get consent forms to review and receive your “Patient & Caregiver Resource Manual.”
- Arrival conference: The next day, you’ll have your arrival conference. You will meet with your doctor and other members of your team to discuss your individualized treatment plan. Every transplant patient at SCCA is cared for by a team that includes an oncologist, a fellow or physician’s assistant, a registered nurse, a pharmacist, a dietitian and a social worker. Your doctor will explain the transplant process, talk with you about the benefits and risks, and answer your questions.
- Evaluation for transplant: Over the next one to two weeks, you will have a thorough evaluation to confirm your diagnosis and evaluate your health to determine whether you are ready for a transplant. Your evaluation will include tests and imaging procedures, such as blood tests, bone marrow aspiration and biopsy, chest X-rays and an electrocardiogram. Throughout this process, you will be an outpatient.
- Data-review conference: After your evaluation, you will have a data-review conference. Your doctor will meet with you to discuss the results of your evaluation, answer your questions and get your consent to proceed with your treatment.
- Education: You and your caregiver will complete classes and get individual instruction on topics like what to expect during the transplant process, how to manage symptoms once you return home and how to maintain proper nutrition so your caregiver can help you through the process.
- Donor: If you have a related donor, this person will be with you, and we will evaluate your donor’s health at this time. If you will have an autologous transplant, this is when we will collect your PBSCs or harvest your marrow to freeze and store for use in your transplant.
When you—and your donor, if you need one—are ready, your doctor will begin your conditioning regimen. This means you’ll receive chemotherapy, total body irradiation or both to weaken or destroy your unhealthy bone marrow.
As these therapies take effect, your immune system will be greatly weakened, and you will be very susceptible to infections. Conditioning may also cause side effects, like nausea, fatigue and skin changes. Your health care team will teach you and your caregiver how to take special precautions to help prevent infections and how to manage side effects. They’ll also give you medicines to help with this.
Conditioning typically lasts about a week. Depending on your treatment plan, you may complete conditioning as outpatient at the SCCA clinic or as inpatient at the University of Washington Medical Center (UWMC).
Your transplant will take place a day or two after your conditioning is complete.
If you are having an allogeneic transplant, one of the following will happen right before your transplant:
- Your donor will undergo stem cell mobilization in the days before your transplant, and then his or her stem cells will be collected on the day of your transplant.
- Your donor will undergo bone marrow harvesting on the day of your transplant.
- Stem cells from cord blood will be prepared for you to receive.
If you are having an autologous transplant, we will have already collected your PBSCs or harvested your marrow before your conditioning, and these will be ready on your transplant day.
The actual transplant involves infusing the cells into your body through a central line, or central intravenous catheter (a small, flexible tube inserted into a large vein near the heart).
Engraftment means the stem cells you received are growing and developing. In other words, your bone marrow function and immune system are beginning to recover. While waiting for engraftment, you’ll be monitored closely for any side effects or complications and be treated for these. Your transplant team and caregiver will provide supportive care as well as emotional support.
Signs of engraftment usually appear about 10 to 28 days after the transplant. The first sign is a rising white blood count. Your team will monitor your blood cell counts to watch for this.
For transplants with high- or moderate-dose conditioning, you will be hospitalized at UWMC for while waiting for engraftment. The length of hospitalization varies, depending on the type of transplant, your response, and many other factors; some patients leave and then return to the hospital more than once as needed. For a mixed chimerism transplant (with low-dose conditioning), patients typically do not need to stay in the hospital while waiting for engraftment.
After your hospital stay, if you have one, you will continue to recover as an outpatient. Your team will develop an individualized plan for your continued care. Support systems are in place for patients and families during this transition.
The initial recovery period typically lasts about three months after the transplant. During this period you will need to live within 30 minutes of either the SCCA clinic or UW MC.
You will be scheduled for clinic visits at least weekly as well as for regular blood draws and other tests to monitor your condition.
The caregiver you selected will help you with your recovery. The education program that’s part of our transplant process will teach you and your caregiver the skills you will need, and you will have detailed instructions in your “Patient & Caregiver Resource Manual.”
Your doctor or nurse will be only a phone call away if you have questions. We will gradually taper off care according to your needs.
Toward the end of your recovery period, you will meet with staff from our Long-Term Follow-Up (LTFU) program, who are dedicated to providing you with life-long support related to your transplant. They will give you a comprehensive transplant discharge evaluation.
Next, you will have a Departure Conference with your attending physician and primary nurse to discuss the results of your discharge evaluation; talk about your ongoing care, what to watch for and how to stay in contact with us as needed; and ask any questions you have. After this conference, you will have a final SCCA clinic visit.
You will also be scheduled to attend a long-term follow-up class at the SCCA clinic about taking care of yourself in the coming year. Your “Patient & Caregiver Resource Manual” will have information about long-term recovery as well.
Once you leave SCCA and return home, you’ll be under the care of your referring doctor. We will give you a packet of information to take with you and give to your referring doctor. The packet contains a summary of all your care at SCCA and recommendations for your care in the future. The LTFU team will be a resource for you and your doctor if you have questions.