Blood and marrow transplants

Treatment for blood cancers can damage the bone marrow. To restore normal blood production after large doses of chemotherapy or radiation, our UCHealth specialists use blood and marrow stem cell transplantation.

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Comprehensive and personalized care

When you choose UCHealth, you gain access to our integrated program for blood cancer and blood and marrow transplant, an approach you won’t usually find at other cancer centers. It means that you receive personalized, coordinated and comprehensive care – and that you’re able to work with the same familiar and trustworthy team of experts for as long as your treatment lasts. In addition, you benefit from the safety and comfort of our special facilities designed to protect your weakened immune system.

A multidisciplinary team

At UCHealth, the same caring team of doctors and support professionals from many fields – including our elite, Magnet-designated nursing staff – collaborate to develop the best plan of care for you. They stay with you from your initial appointment through treatment and aftercare. You receive doctor-managed care that emphasizes wellness and healing for you as a whole person. You can expect care from oncologists/hematologists, hematopathologists, infectious disease specialists, oncology and transplant fellows, nurse practitioners, clinical nurse specialists and others.

Things to consider before a transplant

The choice to undergo a blood or marrow stem cell transplant is a major decision often made under the pressure and crisis of severe illness. As you review your options, you must:

  • Understand complicated medical information.
  • Handle mixed emotions about whether a suitable donor will be found.
  • Consider the possibility of severe side effects and other transplant risks.
  • Respond to the potential strain on your finances.
  • Address the challenges of a long hospital stay, much of it in isolation.

The transplant experience can be psychologically challenging. Still, many people achieve successful results and return to normal activities. One key to success is to learn as much as possible about the blood and marrow transplant process before making your decision.

Blood and marrow transplant process

Evaluation for using the transplant approach includes:

  • Your age, general health and medical condition.
  • Your specific type of cancer.
  • The availability of a tissue-matched donor (allogeneic transplants).

Finding donor stem cells

You and your siblings are tested to determine your tissue type or human leukocyte antigen (HLA) type.

  • You have about a one in four chance of having the same HLA type as your sibling.
  • Compatibility ensures that immune cells of you and your donor will recognize, not attack, each other.

Once a matched and healthy donor is found, he or she undergoes intensive testing for fitness, overall health and to ensure there is no infectious disease. The donor is then treated with a drug that draws stem cells out of the bone marrow and into the bloodstream. Stem cells are recovered from the blood through a process called leukapheresis, which uses a device that removes necessary cells while returning red cells and plasma to the donor.

Conditioning therapy for allogeneic transplants

Conditioning therapy uses chemotherapy drugs and total body irradiation the week before transplant to:

  • Reduce a cancer recurrence by intensively treating the few remaining cancer cells.
  • Limit the chance of graft-versus-host disease by inactivating your immune system.

Stem cell infusion

In a process that lasts less than an hour and resembles a blood transfusion, donor stem cells are infused through one of your veins. Although you may not experience side effects from the infusion, you’re monitored for signs of fever, chills, hives, drop in blood pressure or shortness of breath. Side effects can generally be treated as the infusion process is completed.

While you recover in the hospital

You’ll begin to feel the effects of intensive conditioning therapy and the decrease in bone marrow function by the second or third day after the transplant.

  • Because your immune system has been suppressed, your ability to fight infection is very low.
  • You will stay in our hospital unit equipped with special HEPA-filtered protections that limit your exposure to any type of infection.
  • You may be isolated at the hospital for approximately a month as the donor stem cells begin forming enough blood and immune cells to restore your immune system.
  • You also may receive red cell and platelet transfusions.
  • You will be carefully monitored to make sure your organs function normally.

Like most transplant patients, you may need nutritional support – and for allogeneic transplant patients – special drugs to treat any graft-versus-host disease.

Typically, you will be able to leave the hospital within three (autologous) to five (allogeneic) weeks after your transplant. You will be discharged when:

  • Your bone marrow produces a sufficient number of healthy red cells, white cells and platelets.
  • You have no severe complications.
  • You have a sense of well-being; any mouth sores and diarrhea lessen or are gone.
  • You have a good appetite.
  • You have no fever or vomiting.

After transplant

After leaving the hospital, you’ll recover at home and receive visits from your home care team. In addition, you’ll go to the outpatient clinic for follow-up care every week for about three months. If all is going well after several more months, your venous catheter will be removed, and you’ll have fewer follow-up visits.

If you received an allogeneic transplant, recovering normal blood cell levels and immune cell function typically takes at least six to 12 months. During that time:

  • You’ll need to avoid contact with crowds and with children who have had recent immunizations with live viruses.
  • You may need to be re-immunized for certain diseases because your immunity from previous vaccinations may be reduced.
  • The radiation you received may lead to cataracts in your eyes, sterility in men and premature menopause in women. Women may need estrogen and progesterone replacement therapy.
  • Radiation may decrease thyroid function, and you may require a thyroid hormone.

References

American Cancer Society. Stem Cell or Bone Marrow Transplant – https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/stem-cell-transplant.html

MedlinePlus: National Library of Medicine. Bone marrow transplant – https://medlineplus.gov/ency/article/003009.htm