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What to Expect During a Blood and Marrow Stem Cell Transplant


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During the transplant, doctors and nurses will check your blood pressure, breathing, and pulse, and they’ll watch for signs of fever or chills.

A blood and marrow stem cell transplant has three parts: preparation, transplant, and recovery in the hospital.

Preparation
You’ll check in to the hospital a few days before the transplant. Using a simple surgical procedure, doctors will place a tube in a large vein in your chest. This tube is called a central venous catheter or a central line. It allows easy access to your bloodstream. Doctors will use the central line to give you fluids, medicines, and blood products and to collect blood samples. The tube will stay in place for at least six months after your transplant.

To prepare your body for the transplant, your doctors will give you high doses of chemotherapy and possibly radiation. This treatment destroys the stem cells in your bone marrow that aren’t working right. It also suppresses your body’s immune system so that it won’t attack the new stem cells after the transplant. Some people may get more than one cycle of chemotherapy before their transplants.

The high doses of chemotherapy and radiation can cause side effects, including nausea, vomiting, diarrhea, and tiredness. Medicines can help with these symptoms.

A stem cell transplant is like a blood transfusion. During the procedure, you get donated stem cells through your central line.

Because your immune system is very weak after this treatment, you can easily get an infection. As a result, you’ll stay in a hospital room that has special features that keep the room as clean as possible. Doctors, nurses, and visitors will have to wash their hands carefully and follow other procedures to make sure you don’t get an infection.

Preparation before a stem cell transplant may take up to ten days. The time depends on your medical situation, general health, and whether you need chemotherapy or chemotherapy and radiation.

Transplant
A stem cell transplant is like a blood transfusion. During the procedure, you get donated stem cells through your central line. Once the stem cells are in your body, they travel to your bone marrow and begin making new red blood cells, white blood cells, and platelets.

You’re awake during the transplant. You may get medicine to help you stay calm and relaxed. Doctors and nurses will check your blood pressure, breathing, and pulse, and they’ll watch for signs of fever or chills. Side effects of the transplant can include headache or nausea, but you may not have side effects.

The transplant takes an hour or more. This includes the time to set up the procedure, the transplant itself, and time to check you afterward.

Recovery in the Hospital
You’ll stay in the hospital for weeks or even months after your stem cell transplant. In the first few days after the procedure, your blood cell levels will continue to go down. This is because of the chemotherapy and/or radiation you got before the transplant.

Your doctors will test your blood seven to ten days after the transplant to see whether new blood cells have begun to grow. They’ll check your blood counts every day to track your progress.

You’ll stay in the hospital until your immune system recovers and your doctors are sure that your transplant was successful. During your time in the hospital, your doctors and nurses will carefully watch you for side effects from chemotherapy and radiation, infection, graft-versus-host disease, and graft failure.

Donated stem cells can attack your body. This is called graft-versus-host disease. Your immune system also can attack the donated stem cells. This is called graft failure. These events can be minor or life threatening. They can happen soon after transplant or can develop slowly over months.

Having support from family and friends, especially having someone who can be with you most days in the hospital, can help you recover.

After the Transplant
During the first weeks and months after you leave the hospital, you’ll make frequent trips to an outpatient clinic. This allows your doctors to track your progress. These visits will happen less often over time.

Staff at the clinic will teach you and your caregiver how to care for your central line (which will stay in place for at least six months after your transplant), how to watch for and prevent infections, and other ways to care for you. They also will tell you who to call and what to do in case of an emergency.

Recovery from a stem cell transplant can be slow. It takes six to twelve months to recover normal blood cell levels and immune function. During this time, it’s important for you to take steps to reduce the risk of infection, get plenty of rest, and follow your doctors’ instructions about medicines and checkups.

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Source: National Heart, Lung and Blood Institute, www.nhlbi.nih.gov.

This article was published in Coping® with Cancer magazine, September/October 2010.

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