Blood and Marrow Transplant

Being treated with a blood and marrow transplant

At the Fred Hutchinson Cancer Center Blood and Marrow Transplant Program, we perform more than 400 adult and pediatric blood and marrow transplants (BMTs) each year. Our expert transplant oncologists and BMT team provide a full range of BMT therapies, including one that’s right for you.

We are also world leaders in BMT research and offer many BMT clinical trials. If a clinical trial is appropriate for you and you decide to join, you will see the same physicians and nurses as you would for standard treatment.

As you prepare for your BMT, your transplant team is here to guide you, your family and caregiver to the resources you will need and teach you what you need to know.

Bone marrow transplant The process of treating disease with high doses of chemotherapy, radiation therapy or both. Bone marrow or peripheral blood stem cells are given after treatment to help the body make more blood cells. The process of treating disease with high doses of chemotherapy, radiation therapy or both. Because this treatment destroys the bone marrow’s ability to produce blood cells, bone marrow or peripheral blood stem cells are given after treatment to help the body make more blood cells. Caregiver A person who gives care to people who need help, such as children, older people or patients who have chronic illnesses or disabilities. A person who gives care to people who need help taking care of themselves, such as children, older people or patients who have chronic illnesses or disabilities. Caregivers may be health professionals, family members, friends, social workers or members of the clergy. They may give care at home, in a hospital or in another health care setting. Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Standard care A treatment or other intervention currently being used and considered to be of proven effectiveness based on past studies.

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Here for you

The Fred Hutch Blood and Marrow Transplant Program, located on the sixth floor of the South Lake Union clinic, was designed to support you. It will be you and your caregiver’s “home base” while you are preparing for a transplant and during the transplant process itself.

Most of the places you will need to go, such as the blood draw area, apheresis (stem cell collection) unit, infusion room and pharmacy, are located here. In addition, you and your caregiver will have a mailbox behind the reception desk. We’ll leave messages for you here about your treatment and appointment schedule.

Whenever you need to make a transition during your care — such as going from the hospital to receiving care at the South Lake Union clinic and then to care at home — a Transition Services nurse will be there to help you, too.

Apheresis A procedure in which blood is taken out of the body, part of the blood is removed, and the rest of the blood is infused back into the body. Caregiver A person who gives care to people who need help, such as children, older people or patients who have chronic illnesses or disabilities. A person who gives care to people who need help taking care of themselves, such as children, older people or patients who have chronic illnesses or disabilities. Caregivers may be health professionals, family members, friends, social workers or members of the clergy. They may give care at home, in a hospital or in another health care setting. Infusion An injection of medications or fluids into a vein over a period of time.

To schedule a transplant consultation

phone (800) 804-8824

phone (206) 606-1024

Call us to set up a transplant phone consultation, Monday–Friday, 6:30 am–6 pm. If you are from outside the area and aren’t sure you can travel here for a consultation, please call us to talk about options.

Your transplant path

Step 1: Planning ahead

If your transplant physician recommends a BMT and you decide to move forward, you’ll want to find a caregiver, plan your transportation, make financial arrangements and put other plans in place so you can focus on your treatment and recovery.

Getting Ready for Treatment

The Fred Hutch Preparing for Transplant Manual will also help you get ready. Here you will be able to find detailed answers to most of your questions about treatment, recovery and follow-up care.

Preparing for Transplant Manual (English)

Preparing for Transplant Manual (Spanish)

Step 2: Preparing for transplant

The two main steps in preparing for a transplant are:

Identifying and preparing the donor, whether that’s someone else (allogeneic transplant) or you are your own donor (autologous transplant); and
Going to meetings and evaluations and filling out paperwork at the South Lake Union clinic.

Preparing an allogeneic donor

For an allogeneic transplant, the first step is finding a donor. If you have relatives who are potential donors, we will test them to see if anyone is a close enough match for you.

If not, we will search for you using international donor registries. If we aren’t able to find a match there, you may still be able to receive a haploidentical (haplo) transplant or a cord blood transplant. Today, we are able to find donors for almost everyone who needs one.

Allogeneic stem cell transplant Uses bone marrow or stem cells from a related or unrelated donor whose tissue type closely matches the patient’s. Replaces blood-forming cells that have been destroyed by disease or cancer treatment. Uses bone marrow or stem cells from a donor whose tissue type closely matches the patient’s to replace blood-forming cells that have been destroyed by disease or cancer treatment. This can be from a related or unrelated donor. Cord blood transplant A transplant for patients whose own stem cells have been destroyed by radiation or chemotherapy. It uses stem cells in blood from newborn umbilical cords to replace the blood-forming stem cells.

Preparing an autologous donor

For an autologous transplant, you are your own donor.

With a transplant that uses peripheral blood stem cells (PBSCs), your preparation will include stem cell mobilization. This means you will take medications to help your stem cells move into your bloodstream so they can be collected more easily. Either your Fred Hutch care team or your referring physician will start stem cell mobilization. After you arrive at Fred Hutch, we will collect your PBSCs.

Stem cell A cell from which other types of cells develop. For example, blood cells develop from blood-forming stem cells. Stem cell A cell from which other types of cells develop. For example, blood cells develop from blood-forming stem cells. Stem cell mobilization Using drugs to move stem cells from the bone marrow into the blood. The stem cells can then be collected and stored and used later to replace the bone marrow during a stem cell transplant.

Attending meetings and having evaluations

Next, you will come to the Transplant Clinic on the sixth floor of the South Lake Union clinic for meetings and evaluations and to fill out the paperwork that needs to be completed before your transplant takes place.

Transplant workup

On the first day, you will meet with your primary advanced practice provider and team nurse to discuss your health history, have an exam and blood draw, tour the clinic and get consent forms to review and sign.

Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose.

Arrival conference

The next day, you will meet with your transplant oncologist and team nurse to discuss your treatment plan, your transplant process and any questions you have.

Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

Transplant evaluation

Over the next one to two weeks, you will have a complete medical evaluation, including tests and imaging procedures, to confirm your diagnosis and assess your health.

Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves.

Data-review conference

Your transplant oncologist will meet with you to explain the results of your medical evaluation, answer your questions and get your signature on consent forms, which will allow us to move ahead with your transplant.

Classes and training

You and your caregiver will go to classes on topics like what to expect during the transplant and how to care for your central line, manage symptoms and maintain proper nutrition.

Caregiver A person who gives care to people who need help, such as children, older people or patients who have chronic illnesses or disabilities. A person who gives care to people who need help taking care of themselves, such as children, older people or patients who have chronic illnesses or disabilities. Caregivers may be health professionals, family members, friends, social workers or members of the clergy. They may give care at home, in a hospital or in another health care setting. Central venous catheter A small, flexible tube inserted into a large vein near the heart. This serves as a route for medications and intravenous nutrition and to take blood samples. A small, flexible tube inserted into a large vein near the heart. This serves as a route for medications and intravenous nutrition and to take blood samples. These catheters are also known as a Hickman line, central line, tunneled catheter or Port-a-Cath®. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.

Donor evaluation

If you have a donor who is related to you, they will come to Fred Hutch and we will evaluate their health. If you have a donor who is not a relative, they will be evaluated closer to their home.

Step 3: Conditioning

Conditioning is the therapy — chemotherapy, radiation or both — that you will receive before your transplant. It will weaken or destroy your cancer (or other disease-causing cells) and unhealthy bone marrow before your BMT.

At the same time, conditioning also weakens your immune system, which puts you at risk of infection. Your team will teach you and your caregiver how to help prevent infections and manage any side effects of the conditioning. They can also give you medicines to help.

Conditioning typically lasts about a week. Depending on your treatment plan, you may have conditioning at the South Lake Union clinic or you may be admitted as a patient to the UW Medical Center.

Bone marrow The soft, spongy material in the center of your bones that produces all your blood cells, such as white blood cells, red blood cells and platelets. Bone marrow transplant The process of treating disease with high doses of chemotherapy, radiation therapy or both. Bone marrow or peripheral blood stem cells are given after treatment to help the body make more blood cells. The process of treating disease with high doses of chemotherapy, radiation therapy or both. Because this treatment destroys the bone marrow’s ability to produce blood cells, bone marrow or peripheral blood stem cells are given after treatment to help the body make more blood cells. Caregiver A person who gives care to people who need help, such as children, older people or patients who have chronic illnesses or disabilities. A person who gives care to people who need help taking care of themselves, such as children, older people or patients who have chronic illnesses or disabilities. Caregivers may be health professionals, family members, friends, social workers or members of the clergy. They may give care at home, in a hospital or in another health care setting. Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Conditioning Treatments to prepare patients for stem cell transplantation. May include chemotherapy, monoclonal antibody therapy and radiation. The treatments used to prepare a patient for stem cell transplantation (a procedure in which a person receives blood stem cells, which make any type of blood cell). A conditioning regimen may include chemotherapy, monoclonal antibody therapy and radiation to the entire body. It helps make room in the patient’s bone marrow for new blood stem cells to grow; prevent the patient's body from rejecting the transplanted cells; and kill any cancer cells that are in the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

Tests that may be needed

You may need to have tests or scans before your conditioning, such as screening for infectious diseases; an organ function exam; or chest X-ray or image scans like PET and CT. If so, your care team will give you the information you need and help prepare you.

Chest X-ray A type of high-energy radiation that can go through the body and onto film, making pictures of areas inside the chest, which can be used to diagnose disease. An X-ray is a type of high-energy radiation that can go through the body and onto film, making pictures of areas inside the chest, which can be used to diagnose disease. Computed tomography A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are used to create three-dimensional (3-D) views of tissues and organs. A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create three-dimensional (3-D) views of tissues and organs. A dye may be injected into a vein or swallowed to help the tissues and organs show up more clearly. This scan may be used to help diagnose disease, plan treatment or find out how well treatment is working. Conditioning Treatments to prepare patients for stem cell transplantation. May include chemotherapy, monoclonal antibody therapy and radiation. The treatments used to prepare a patient for stem cell transplantation (a procedure in which a person receives blood stem cells, which make any type of blood cell). A conditioning regimen may include chemotherapy, monoclonal antibody therapy and radiation to the entire body. It helps make room in the patient’s bone marrow for new blood stem cells to grow; prevent the patient's body from rejecting the transplanted cells; and kill any cancer cells that are in the body. Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease.

Step 4: Receiving your stem cells

Your transplant will involve infusing stem cells into your body through a thin, flexible tube inserted into a vein. Click the sections below to learn what happens before your transplant.

Stem cell A cell from which other types of cells develop. For example, blood cells develop from blood-forming stem cells.

Before an allogeneic transplant

In the days before your transplant, your donor will go through a process called stem cell mobilization. This means they will take medications to help their stem cells move into the bloodstream so they can more easily be collected. Then, on the day of your transplant, your donor’s stem cells will be collected.

If you are having a bone marrow transplant, your donor will do a bone marrow collection on the day of your transplant. To do this, a needle is inserted into your donor’s hip bone. Your donor will be given anesthesia, so they will not feel any pain when this happens.

Anesthesia Drugs or other substances that cause a loss of feeling or awareness. This keeps patients from feeling pain during surgery or other procedures. A loss of feeling or awareness caused by drugs or other substances. Anesthesia keeps patients from feeling pain during surgery or other procedures. Local anesthesia is a loss of feeling in one small area of the body, such as the mouth. Regional anesthesia is a loss of feeling in a part of the body, such as an arm or leg. General anesthesia is a loss of feeling and a complete loss of awareness that feels like a very deep sleep. Bone marrow The soft, spongy material in the center of your bones that produces all your blood cells, such as white blood cells, red blood cells and platelets. Stem cell A cell from which other types of cells develop. For example, blood cells develop from blood-forming stem cells. Stem cell A cell from which other types of cells develop. For example, blood cells develop from blood-forming stem cells.

Before an autologous transplant

For an autologous transplant, your peripheral blood stem cells (PBSCs) are collected before you receive conditioning. These cells are stored until they are needed for your transplant infusion.

Conditioning Treatments to prepare patients for stem cell transplantation. May include chemotherapy, monoclonal antibody therapy and radiation. The treatments used to prepare a patient for stem cell transplantation (a procedure in which a person receives blood stem cells, which make any type of blood cell). A conditioning regimen may include chemotherapy, monoclonal antibody therapy and radiation to the entire body. It helps make room in the patient’s bone marrow for new blood stem cells to grow; prevent the patient's body from rejecting the transplanted cells; and kill any cancer cells that are in the body. Infusion An injection of medications or fluids into a vein over a period of time. Stem cell A cell from which other types of cells develop. For example, blood cells develop from blood-forming stem cells.

Before a cord blood transplant

If you are having a cord blood transplant, stem cells from the cord blood have already been collected and frozen, and will be prepared for your transplant infusion.

Cord blood transplant A transplant for patients whose own stem cells have been destroyed by radiation or chemotherapy. It uses stem cells in blood from newborn umbilical cords to replace the blood-forming stem cells. Infusion An injection of medications or fluids into a vein over a period of time. Stem cell A cell from which other types of cells develop. For example, blood cells develop from blood-forming stem cells.

Step 5: Waiting for engraftment

Engraftment is when the infused stem cells begin growing and developing, which usually happens in about 10 to 28 days. You’ll have frequent blood tests to check for a rising white blood cell count, which is usually the first sign of engraftment. This is also a sign that your bone marrow and immune system are beginning to recover.

In the meantime, we’ll monitor you closely and treat any side effects or complications you might have. Your transplant team and caregiver will provide supportive care and emotional support, too.

Bone marrow The soft, spongy material in the center of your bones that produces all your blood cells, such as white blood cells, red blood cells and platelets. Caregiver A person who gives care to people who need help, such as children, older people or patients who have chronic illnesses or disabilities. A person who gives care to people who need help taking care of themselves, such as children, older people or patients who have chronic illnesses or disabilities. Caregivers may be health professionals, family members, friends, social workers or members of the clergy. They may give care at home, in a hospital or in another health care setting. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose. Stem cell A cell from which other types of cells develop. For example, blood cells develop from blood-forming stem cells. White blood cell A type of blood cell that is made in the bone marrow and found in the blood and lymph tissue. White blood cells are part of the body’s immune system and help the body fight infection and other diseases. A type of blood cell that is made in the bone marrow and found in the blood and lymph tissue. White blood cells are part of the body’s immune system. They help the body fight infection and other diseases. Types of white blood cells include granulocytes (neutrophils, eosinophils and basophils), monocytes and lymphocytes (T cells and B cells). Checking the number of white blood cells in the blood is usually part of a complete blood cell (CBC) test. It may be used to look for conditions such as infection, inflammation, allergies and leukemia. Also called leukocyte and WBC.

Where you will stay

If you had a high-dose conditioning, you’ll stay at the University of Washington Medical Center. The amount of time you’ll need to stay will depend on the type of transplant you had, how quickly your body responds to treatment and other factors.

If you had a reduced-intensity, or non-myeloablative, transplant, you will most likely come to the South Lake Union clinic for appointments instead of staying inpatient at the hospital.

Step 6: Recovering after engraftment

If you had an allogeneic (donor) transplant, you can expect your recovery to last about three months. If you had an autologous transplant, where your own cells were used, you can expect recovery to take about one month.

You will have appointments at least once a week, as well as blood draws and other tests. As you recover, you’ll gradually come in less often.

Keep in mind, your caregiver is there to help you with not only your physical needs during your recovery, but your practical and emotional needs, too. A transplant nurse is also available by phone 24 hours a day, seven days a week, to answer questions and help you and your caregiver.

Some people who have a blood or marrow transplant do not have many problems during engraftment and recovery. Others may have complications like infection, bleeding, liver damage or pneumonia.

Caregiver A person who gives care to people who need help, such as children, older people or patients who have chronic illnesses or disabilities. A person who gives care to people who need help taking care of themselves, such as children, older people or patients who have chronic illnesses or disabilities. Caregivers may be health professionals, family members, friends, social workers or members of the clergy. They may give care at home, in a hospital or in another health care setting. Pneumonia A severe inflammation of the lungs in which the alveoli (tiny air sacs) are filled with fluid. This may reduce the amount of oxygen that blood can absorb from air breathed into the lung. A severe inflammation of the lungs in which the alveoli (tiny air sacs) are filled with fluid. This may reduce the amount of oxygen that blood can absorb from air breathed into the lung. Pneumonia can be caused by infection, radiation therapy, allergy or irritation from inhaled substances. It may involve part or all of the lungs.

Preventive care during recovery

During engraftment and while you are recovering, you may have some tests. We may also prescribe medications, such as antibiotics to prevent infection; blood transfusions to prevent bleeding; or medications to prevent infection and a complication called graft-versus-host disease (GVHD). If you’re having any side effects, we have medications and treatments that can help.

Our expert transplant oncologists and team members know how to recognize early signs of complications, from common to rare. This allows them to step in and address issues quickly, so complications can be avoided whenever possible.

Sometimes complications are unavoidable. When this happens, your team knows how to offer the best medicines, therapies, procedures and approaches to treat them. Two issues that can happen during blood or marrow transplant are GVHD and stem cell (graft) failure.

Graft-versus-host disease A condition that occurs when donated stem cells or bone marrow (the graft) see the healthy tissues in the patient’s body (the host) as foreign and attack them. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose. Stem cell A cell from which other types of cells develop. For example, blood cells develop from blood-forming stem cells.

Graft-versus-host disease (GVHD)

If the donor stem cells that make up a patient’s new immune system recognize the patient’s tissues and organs as foreign and attack them, the condition is called graft-versus-host disease (GVHD). GVHD can happen at any time after an allogeneic (donor) transplant and can range from mild to severe. There are two types of GVHD:

Acute GVHD: Typically happens within a few months after transplant and usually affects the skin, digestive tract or liver.
Chronic GVHD: Usually develops within a year or two after transplant and can affect many organs.

Digestive tract The organs that food and liquids travel through when they are swallowed, digested and absorbed before leaving the body as feces. The organs that food and liquids travel through when they are swallowed, digested and absorbed before leaving the body as feces. These organs include the mouth, pharynx (throat), esophagus, stomach, small intestine, large intestine, rectum and anus. The digestive tract is part of the digestive system. Also called alimentary tract and gastrointestinal tract. Graft-versus-host disease A condition that occurs when donated stem cells or bone marrow (the graft) see the healthy tissues in the patient’s body (the host) as foreign and attack them. Stem cell A cell from which other types of cells develop. For example, blood cells develop from blood-forming stem cells.

Stem cell failure

Stem cell failure, or graft failure, is a rare complication that happens when donor cells are rejected by a patient’s immune system.

If this happens and more donor cells are available, it may be possible for a patient to have a second transplant. A physician may also be able to treat a patient using an infusion of a type of white blood cell that comes from a donor.

Infusion An injection of medications or fluids into a vein over a period of time. Stem cell A cell from which other types of cells develop. For example, blood cells develop from blood-forming stem cells. White blood cell A type of blood cell that is made in the bone marrow and found in the blood and lymph tissue. White blood cells are part of the body’s immune system and help the body fight infection and other diseases. A type of blood cell that is made in the bone marrow and found in the blood and lymph tissue. White blood cells are part of the body’s immune system. They help the body fight infection and other diseases. Types of white blood cells include granulocytes (neutrophils, eosinophils and basophils), monocytes and lymphocytes (T cells and B cells). Checking the number of white blood cells in the blood is usually part of a complete blood cell (CBC) test. It may be used to look for conditions such as infection, inflammation, allergies and leukemia. Also called leukocyte and WBC.

Step 7: Preparing to leave/discharge

If you had an allogeneic transplant

You will meet with a clinical team from the Fred Hutch Long-Term Follow-Up (LTFU) Program at Fred Hutch toward the end of your initial recovery period. They are dedicated to providing you with lifelong resources and will work with your team to give you an in-depth transplant discharge evaluation.

Learn More

If you had an autologous transplant

You will not face the same long-term issues as a patient who had an allogeneic transplant and should not require Fred Hutch Long-Term Follow-Up (LTFU) Program services. However, if it’s needed, you can plan visits through our LTFU telemedicine program after you leave.

Departure conference

Next, you will have a departure conference with a transplant oncologist and registered nurse to talk about your discharge evaluation, your ongoing care, what to watch for and how to stay in contact with us. We’ll also answer any questions you have, and you’ll have a final Fred Hutch clinic visit.

Home care class

You’ll go to a class about taking care of yourself in the coming year. This weekly class will provide you with specific instructions on how to care for yourself after leaving Fred Hutch.

Going home

Once you return home, your referring physician will continue to care for you. Your physician will receive detailed information from us about your treatment at Fred Hutch and recommendations for your care in the future. You will also be able to access resources from the Fred Hutch Long-Term Follow-Up (LTFU) Program.

You can also access this information in these videos:

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