Your blood and marrow transplant path at SCCA
Deciding to have a blood or bone marrow transplant is the first step in a new and challenging phase of your treatment. There will be much to prepare for, not only for the transplant, but also for your recovery afterward. The experienced transplant team at Seattle Cancer Care Alliance (SCCA) will guide you throughout the process, providing comprehensive care, expert support and detailed information about what to expect.
For many people, the process begins with an initial consultation at the SCCA clinic to discuss the possibility of a transplant. You will meet with a transplant oncologist, who 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, explain the transplant process in depth and offer you a tour of our clinic and facilities.
You will have the option to meet with a representative from Patient Financial Services to talk about treatment costs, insurance coverage and how to pay for your transplant. We will give you a packet of transplant information to take home.
Step 1: planning ahead
Once your team recommends a transplant and you decide to move forward, you’ll want to put plans in place so you can give your full attention to your recovery. Our manual for patients and families, called Preparing for Transplant will help with planning.
Things to consider when planning ahead:
Selecting a caregiver, a responsible adult family member or friend to provide physical care, help monitor your health, give you medications and offer emotional support. We will teach your caregiver about these duties. They’ll need to be with you most of the time for many weeks.
Arranging to live in Seattle, within 30 minutes of the clinic for your safety. The length of time depends on your disease, treatment plan and response to treatment. It’s typically four months if you’re receiving cells from someone else and one month for a transplant using your own cells.
Step 2: preparation
Two main elements of preparing for a transplant are preparing the donor — whether that’s someone else (allogeneic transplant) or you are your own donor (autologous transplant) — and arriving at SCCA for the meetings, evaluations and paperwork that need to happen right before your transplant takes place.
Preparing the donor
For an allogeneic transplant, preparation includes finding a donor. If you have relatives available to donate, they will be tested to see if any is a close-enough match for you. If not, we will search international donor registries. If a match isn’t found, you may be able to receive a haploidentical transplant or a cord blood transplant.
For an autologous transplant, you are your own donor. For a transplant using peripheral blood stem cells (PBSCs), your preparation will include stem cell mobilization. Either SCCA or 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 here.
Arriving at SCCA
Next, you will come to SCCA for:
- Transplant workup — On the first day, you will meet with your primary provider and team nurse to discuss your health history, have an exam and blood draw, tour the clinic, get consent forms to review and receive your transplant manual.
- Arrival conference — The next day, you will meet with your attending doctor and team nurse to discuss your treatment plan, your transplant process and any questions you have.
- Evaluation for transplant — Over the next week or two, you will have a thorough evaluation, including tests and imaging procedures, to confirm your diagnosis and assess your health.
- Data-review conference — Your attending doctor will meet with you to explain results of your evaluation, answer your questions and get your official consent to move ahead with a transplant.
- Education — You and your caregiver will attend classes and get one-on-one instruction on topics like what to expect during the transplant and how to care for your central line, manage symptoms and maintain proper nutrition.
- Donor evaluation — If you have a related donor, they will be with you, and we will evaluate your donor’s health. If you have an unrelated donor, they will be evaluated closer to their home.
Most of your outpatient appointments and treatment will take place in the Transplant Clinic on the 6th floor of the SCCA South Lake Union clinic. This will be your family’s “home base” while you are being evaluated for a transplant and during the transplant process itself.
Your family will have a mailbox behind the 6th-floor reception desk, where you can check for appointment schedules and messages. Many of the other services you will need — such as the infusion room, blood draw area, apheresis unit and pharmacy — are conveniently located in the same building.
Step 3: conditioning
When you — and your donor, if you need one — are ready, your doctor will begin your conditioning. You’ll receive chemotherapy, total body irradiation or both to weaken or destroy your cancer (or other disease-causing cells) and unhealthy bone marrow. This will weaken your immune system, making you susceptible to infections. Your team will teach you and your caregiver how to help prevent infections and manage other side effects you may have. They’ll also give you medicines to help.
Conditioning typically lasts about a week. Depending on your treatment plan, you may have conditioning as an outpatient at the SCCA clinic or as an inpatient at the SCCA Hospital at University of Washington Medical Center (UWMC).
Your Transition Services nurse will help you prepare for the transitions that will occur throughout your transplant process — such as the transition from your inpatient hospital stay, if you have one, to outpatient care at the SCCA clinic and then to care at home.
Step 4: transplant
Your transplant involves infusing cells into your body through a thin, flexible tube inserted into a vein.
For 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 their 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.
For an autologous transplant, we will have already collected your peripheral blood stem cells or harvested your marrow before your conditioning. These will be defrosted, in preparation for infusion.
Throughout, you will be cared for by a team that specializes in the type of transplant you are having. Your team includes an expert transplant oncologist; a fellow, physician’s assistant or advanced registered nurse practitioner; and a registered nurse, pharmacist, dietitian, team coordinator and social worker.
Step 5: waiting for engraftment
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 any side effects or complications that might arise. Your transplant team and caregiver will provide supportive care as well as emotional support. You’ll have blood tests to check for a rising white blood count — the first sign of engraftment, which usually appears in about 10 to 28 days.
For a transplant with high-dose conditioning, you will be hospitalized at the SCCA Hospital while waiting for engraftment. The length of hospitalization varies depending on the type of transplant, your response and many other factors. For a reduced-intensity, or non-myeloablative, transplant, you may not need to stay in the hospital.
Step 6: recovering after engraftment
You will continue to recover as an outpatient. 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 live within 30 minutes of the SCCA clinic or UWMC. You will have clinic visits at least weekly as well as blood draws and other tests. We will gradually taper the frequency of your visits according to your needs.
Your caregiver will help you with your recovery. A transplant registered nurse is available by phone 24 hours a day, 7 days a week to help you and your caregiver.
Step 7: long-term recovery
Toward the end of your initial recovery period, you may meet with staff from our Long-Term Follow-Up (LTFU) Program if you had an allogeneic transplant. They are dedicated to providing you with lifelong resources and 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 after you leave, you can plan visits through our LTFU telemedicine program.)
Next, you will have a departure conference to talk about your discharge evaluation, your ongoing care, what to watch for, how to stay in contact with us and any questions you have, and you’ll have a final SCCA clinic visit. You’ll also attend a class about taking care of yourself in the coming year.
Once you leave SCCA and return home, you’ll be under the care of your referring doctor. We will give you a packet for your doctor with a summary of your care at SCCA and recommendations for your care in the future. Your transplant manual will have information about long-term recovery as well. The LTFU team will be a resource for you and your doctor if you have any questions.