The Transplant Process

The process of transplant can be divided into seven steps. Each step has its own purpose and challenges. These steps are outlined below, but as a transplant patient, you’ll receive in-depth information about your transplant and the process.

Step 1: Planning Ahead
After you’ve decided to have a transplant, you’ll want to make a few plans to ease the process.

• Assess your financial coverage and other financial resources. You may even consider fundraising. More information is available at SCCA to assist you.
• Select your caregiver.
• Make decisions about child care and/or schooling.
• Plan your stay in Seattle if you don’t live locally.

Step 2: Preparation
The next step includes meeting the members of your medical team, undergoing a medical evaluation, having several conferences to read and sign consent forms and protocols, ask questions, and make a plan on how to cope with transplant. There are classes for patients and caregivers to help. Your central venous catheter is inserted, and if you’re an autologous transplant patient, the collection and storage of your marrow or peripheral blood stem cells will take place. Keep active during this time, walking or doing some other exercise.

Step 3: Conditioning
The conditioning stage prepares you for the transplant. It may be done at SCCA or at UW Medical Center as an inpatient. You will want to make sure to balance rest and activity to help maintain your energy level.

Conditioning removes cancer cells or the remaining immune system from your body so that new marrow has room to grow. Traditionally, this is either high-dose chemotherapy and/or radiation therapy. In a mini transplant, moderate medications and radiation are used.

Side Effects of Conditioning Side effects of the conditioning therapy may include nausea, vomiting, diarrhea, dry mouth, fatigue, and skin changes. These can typically be managed with other drugs. Frequent mouth rinses are helpful, too.

Some of the side effects of chemotherapy happen right away. Detailed information regarding the specific chemotherapy drugs and their side effects will be discussed by your health-care team.

Radiation therapy is given to the entire body, two times a day in small fractions over a number of days. There is no pain involved. Detailed information regarding radiation and the treatment of its side effects will be discussed by your health-care team.

Step 4: Transplant
The transplant takes place a day or two after chemotherapy and/or radiation is completed. The goal is to infuse the stem cells from which all type of blood cells will grow. These cells can be collected from bone marrow, from circulating blood, or from saved umbilical cord blood after a baby’s birth.

To read about Donor Information, click here.

Many families choose to celebrate the transplant day as a special occasion.

Step 5: Waiting for engraftment
Engraftment means that the bone marrow or stem cells you received during the transplant are growing and beginning to produce new blood cells. Signs of engraftment usually are seen about 10 to 28 days after the transplant.
Often the first sign is a rising white blood cell count. Your blood cell counts will be monitored to watch for this.

You will be very susceptible to infections during this time because of the lack of white blood cells. You will receive transfusions of blood cells or platelets if needed to boost your counts.

You also will be monitored closely for any side effects or complications of the treatment. Possible complications include viral, bacterial, and fungal infections; pneumonia; veno-occlusive disease (VOD), also called sinusoidal obstruction syndrome (SOS), of the liver and other organ failure. The risk of organ failure may be greater in patients who already have had intensive chemotherapy or radiation therapy or both before coming for a transplant.

During this time, you may want to take advantage of the support services available to you and your family, including social workers. Keep as active as possible and set goals for each day. Watch the progress you are making!

For a standard transplant, you will be hospitalized while waiting for engraftment. This is not the case for a mini transplant.

Step 6: Recovery after engraftment
After your hospital stay, if you have one, you will continue to recover as an outpatient. You will need to live within 15 or 30 minutes driving distance of either Seattle Cancer Care Alliance clinic or University of Washington Medical Center during this time.

Your designated caregiver will help you with recovery: giving medications, monitoring your symptoms, and more. We have classes to teach you the skills you will need, and you will have detailed instructions in the “Patient & Caregiver Resource Manual” as well. Your doctor or nurse is only a phone call away if you have questions.

During this time, you’ll get back to eating regular meals, and gradually increase activity, alternating with rest periods for recovery. Take things day-by-day and keep track of daily goals to see your progress. Get out and do something fun!

Toward the end of the recovery period, you will meet with staff from the Long-Term Follow-Up team.

Step 7: Long-term recovery
Once you leave SCCA and return home, you will be under the care of your referring doctor. You should report any new symptoms to your doctor promptly and contact the Long-Term Follow-Up staff if you have any questions.  Allogenic transplant patients return to SCCA one year after their transplant for an evaluation.

March 2007