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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Step 7: Preparing to leave/discharge
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.
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.
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.
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: