Three phases of bone marrow transplantation:
A number of tests are carried out to ensure that patient is healthy enough for the treatment. All tests are done after the admission in the hospital.
Routine- If you have not been admitted to the hospital before, it may help to read the following paragraphs, which describe some of the events and tests that are routinely carried out.
Blood tests- Blood tests are sometimes performed as often as every day, depending on patient’s treatment and general condition. These are important, but patient may find them tiresome. Blood can either be taken from a vein (peripheral sampling) or nurse can take it from patient’s central venous catheter if patient’s have one. Blood samples are usually taken in the morning, but sometimes, additional samples may be required at other times of the day. Healthcare team carefully watches the results of all of investigations.
X rays Chest- X rays are performed as often as weekly for patients who are having, or have had, chemotherapy. This is because there are some types of lung infection that do not show any symptoms until they are severe and so by performing regular X rays, some of these infections can be found early.
Observations – While Patient are in hospital, there are various ways of monitoring patient’s condition. The most common are described below.
Temperature- This may be checked frequently over the course of the day. A thermometer may be placed in patient’s mouth (under your tongue), or if you have a sore mouth, or feel nauseous, patient can place it under arm. The reading obtained from using the second method is usually lower. There is a newer type of thermometer, which is placed in the outer ear, and can read the temperature electronically using an infra-red sensor.
Pulse- This may be checked frequently over the course of the day. Patient may find that patient’s pulse rate is faster if patients are anaemic or if patient’s have a raised temperature when he/she have an infection.
Blood pressure- This may be checked frequently over the course of the day. Patient may find that patient’s blood pressure runs a little lower than normal when patient have a raised temperature, or a little higher if patient are anxious or in pain.
Respiration rate- This may be checked frequently over the course of the day. Patient’s respiration rate tells how quickly or slowly patient’s are breathing. The rate may be quick if patients are anxious or in pain, or have an infection, and slow if patient are asleep or drowsy.
Fluid monitoring– Because of this types of treatment patient’s are given, it is necessary to ensure that you are getting plenty of fluid, either by mouth or by drip. It is also necessary to ensure that you are passing sufficient amounts of urine. Too much fluid in your body can be a problem, while too little can lead to dehydration. High fluid intake can help to flush harmful toxins and waste products away. To monitor your input and output, a fluid balance chart is used. This is a record of your input (drinks, intravenous infusions) and output (urine and other body fluids). The nurse may suggest that patient’s will keep his/her own record.
Pulse oximeter – This is a machine that can be used to measure the level of oxygen in the blood. Oxygen in the blood is important as it helps to provide nutrients to the cells of patient’s body.
The preparation phase begins when the patient reached at the hospital. It includes the process of medical evaluation, orientation, informed consent, and other preliminary activities.
a) Starting of medical evaluation
b) Initiation of conference related to the treatment plan
c) Central Venous catheter evaluation and insertion
d) Bone- Marrow Harvest
This phase initiates the actual transplant process. During this phase, high-dose chemotherapy, radiation therapy, or both are initiated. Chemotherapy and radiation therapy are given in doses that destroy the function of marrow and result in the greatest possibility of destroying the disease.
Depending upon the chemotherapy agents and radiation therapy administration schedule, some conditioning therapy can be administered in the outpatient setting, thus potentially shortening the inpatient stay.
The transplant phase is the infusion of donor bone marrow or stem cells. After the conditioning regimen is completed, the patient receives the infusion of bone marrow or stem cells.
Waiting for Engraftment: This phase consists of close monitoring, supportive treatment, and management of complications while waiting for signs of engraftment/ enlargement (new cell growth).
Engraftment and Early Recovery: Approximately after 10 to 28 days of marrow transplant, signs that the new bone marrow or stem cells are engrafting (growing and developing) can be expected.
Close monitoring will continue along with supportive care. Preparation for the return of the patient to the referring physician or hospital will begin.
Long-Term Recovery: The long-term recovery phase involves leaving the treatment center, dealing with any ongoing clinical issues, and re-establishing life patterns. Patients need to follow up for long term complications of BMT.
The main risks associated with a stem cell transplant are outlined below.
Graft versus host disease: GvHD can occur within a few months of the transplant or develop several months.