Bone Marrow Transplant: The Seven Steps
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 health care team will discuss your treatment plan with you and your family and answer all your questions before your treatment begins. You’ll get a detailed book 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 team registered nurse and Transition Services team will guide you through the process.
- Initial Consultation
- Step 1: Planning Ahead
- Step 2: Preparation
- Step 3: Conditioning
- Step 4: Transplant
- Step 5: Waiting for Engraftment
- Step 6: Recovering After Engraftment
- Step 7: Long-Term Recovery
For many people, the process begins with an initial consultation at the SCCA clinic to discuss the possibility of a transplant. Here’s what you can expect at your consultation.
- You will meet with a transplant oncologist who has expertise in the treatment of blood cancers with stem cell transplantation. 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 answer your questions and offer you an orientation and tour.
- You will meet with a representative from Patient Financial Services to talk about how much treatment costs, what your insurance covers, 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 your medical team recommends a transplant for you and you decide to proceed, you will begin the seven steps listed below. These steps are described in more detail in Preparing for Transplant.
You’ll want to organize your personal affairs and put plans in place so you can give your full attention to your recovery. We’ll send you a copy of Preparing for Transplant to help you with important matters such as:
- Selecting a caregiver, a responsible adult 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. Your caregiver must be available to be with you most of the time for many weeks.
- Arranging to live in Seattle for your transplant, if you don’t live here already. We require that you live within 30 minutes of the clinic for your safety. The length of time is different for each person and depends on your disease, 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 one month for an autologous transplant and four months for an allogeneic transplant.
- Bringing your children with you or not, 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 of preparing for a transplant are preparing the donor (whether that’s someone else or you are your own donor) and arriving at SCCA for the meetings, evaluations, and paperwork that need to happen right before your transplant occurs.
Preparing the Donor
Allogeneic transplant: 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, they will be tested to see if any is a close-enough match for you according to HLA typing.
- If you do not have a related donor, we will search internationally for an unrelated donor using donor registries.
- If a match cannot be found, you may be able to receive a haploidentical transplant (using a half-matched family member) or a cord blood transplant (using an unrelated donor). Read more about options for people without a match.
Autologous transplant: If you will have an autologous transplant (using your own cells), you are your own donor.
- For a transplant using peripheral blood stem cells (PBSCs): 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 bloodstream). Sometimes we will begin your stem cell mobilizations; sometimes your referring doctor will start this process. After you arrive at SCCA, we will collect your PBSCs.
- For a transplant using bone marrow: 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.
- Transplant workup: On the first day, you will meet with your primary provider and team 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 attending doctor and team nurse to discuss your treatment plan. Every transplant patient at SCCA is cared for by a team that includes an oncologist; a fellow, a physician’s assistant, or an advanced registered nurse practitioner; and 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. 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 attending doctor will meet with you to discuss the results of your evaluation, answer your questions, and get your consent, if you wish to proceed with your treatment.
- Education: You and your caregiver will attend classes and get individual instruction on topics like what to expect during the transplant process, how to care for your central venous catheter, how to manage symptoms once you return home, and how to maintain proper nutrition. This will prepare your caregiver to 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 have an unrelated donor, that person will be evaluated at a different center closer to their home.
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 cancer (or other disease-causing cells) and 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 other 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 University of Washington Medical Center (UWMC).
Your transplant will take place 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 defrosted, in preparation for infusion.
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 defrosted, in preparation for infusion.
The actual transplant involves infusing the cells into your body through a central venous catheter (a small, flexible tube inserted into a large vein leading to your heart).
Engraftment means the stem cells you received are growing and developing. In other words, your bone marrow and immune system are beginning to recover. While waiting for engraftment, we’ll closely monitor you and treat you for any side effects or complications that arise. 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-dose conditioning, you will be hospitalized at UWMC while waiting for engraftment. The length of hospitalization varies, depending on the type of transplant, your response, and many other factors; some people leave and then return to the hospital more than once as needed. For a reduced-intensity transplant (with reduced-dose conditioning), patients may 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 a plan for your continued care. You will be seen in the clinic at least once a week; two or three times a week is more usual.
The initial recovery period typically lasts about three months after an allogeneic transplant and about one month after an autologous transplant. During this period you will need to continue to live within 30 minutes of either the SCCA clinic or UWMC.
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.
We will gradually taper off the frequency of your visits according to your needs. A transplant registered nurse is available by phone 24 hours a day, 7 days a week.
Toward the end of your recovery period after an allogeneic transplant, you may meet with staff from our Long-Term Follow-Up (LTFU) program. They are dedicated to providing you with life-long resources related to your transplant. They will work with your team to give you a comprehensive transplant discharge evaluation. If you had an autologous transplant, you will not face the same long-term issues; if needed, you can plan return visits through our LTFU telemedicine program after you leave.
Next, you will have a departure conference with your attending doctor 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 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.