When the time comes for your BMT, the process will vary depending on what kind of transplant you will have. Click on the links below to learn more about what to expect during the BMT process.

Allogeneic transplant process

Autologous transplant process

What happens during and right after the transplant?

Who will take care of you in the hospital?

Regular nursing care

Intesive nursing care

Your daily routine

Infection control

Allogeneic transplant

• You will receive stem cells from a donor (related, unrelated, or cord blood).
• You will have your pre-transplant work-up in the BMT outpatient clinic.
• We will admit you to the hospital for a preparative regimen of chemotherapy and/or radiation . This helps prepare your body for transplant. In some cases we may use this regimen to weaken or suppress your immune system. This gives your new stem cells a better chance to grow and engraft after the transplant. This regimen typically takes between one to two weeks.
• You will have your transplant in the hospital.
• You will remain in the hospital until your immune system is strong enough again to protect you from infection.
• A typical stay is two to four weeks depending on type of transplant you have. It may be longer if you have complications.
• After you leave the hospital you will need to make frequent follow-up visits to the BMT outpatient clinic.

Autologous transplant
In some cases, we may do chemotherapy and transplant in the outpatient clinic, instead of in the hospital. This depends on your diagnosis and the status or your disease. Your BMT doctor can let you know whether having your treatment in the outpatient clinic is a good option for you.

• You will receive your own stem cells back into your body for transplant.
• We will collect your stem cells before transplant and then process and freeze them.
• You will have your pre-transplant work-up in the BMT outpatient clinic.
• You will receive a preparative regimen of chemotherapy and/or radiation to treat your cancer .
• We will thaw the stem cells we collected before your transplant and then reinfuse them into your body.
• We can sometimes perform autologous transplant in the outpatient clinic (instead of in the hospital).
• After the transplant (or after you leave the hospital), you will need to make frequent follow-up visits to the BMT outpatient clinic.
  

What happens during and right after the transplant?
The transplant takes place after chemotherapy and radiation treatment are done. During the transplant, a doctor puts stem cells into your bloodstream. Unlike a solid organ transplant, BMT is not surgery. It is more similar to a blood transfusion. And it takes about an hour or less to complete.

The first day of your transplant is called day zero.

We may give you medicines before the transplant to help prevent or manage side effects such as chills or nausea. Before, during and after the transplant, we will check your vital signs to monitor your condition. Next, we give you the healthy marrow or stem cells through an IV that is connected to a central venous catheter. If the transplant cells are cord blood or stem cells that were frozen, you may feel queasy and have an unusual tast in you mouth during the infusion. Some people also notice an unusual body odor. These reactions are caused by a preservative that is used to protect the stem cells when they are frozen. The taste and the smell will go away in a few days.

The cells will travel through your bloodstream until they reach the bone marrow. There, they begin to grow and divide, making new red and white blood cells and platelets. This process is called "engraftment." Your blood cell counts will typically return to normal levels about two to four weeks after the transplant. We might also use "growth factors" (medicines) to speed up the engraftment.

While you are waiting for engraftment, you body is unable to make enough white blood cells to fight infection. this means you are at greater risk for infection. We will takely weekly cultures of blood, throat cells, urine, and stool to watch for infection. You will also receive medicines to help prevent infection. Many peopole have a fever, which is often the first sign of infection, and chills in the weeks following BMT.

While the new stem cells are growing, you will need transfusions of red blood cells and platelets to replace those that the stem cells are not producing yet. There is always a chance that you will have a reaction to transfusions of blood products. Symptoms include fever, chills, hives, and shortness of breath. If you have had a bad reaction to blood products in the past, tell the medical team. We can give you medicines to help prevent reactions. 

Blood products are always tested to prevent certain infections. They are also irradiated to destroy certain cells in the blood transfusion that can compete with the new stem cells and cause transfusion associated GVHD. 

After the new cells engraft, new marrow begins to manufacture healthy blood cells. New white blood cells help to fight off infections and mount an immune attack against any cancer cells that are still in your body.

Who will take care of you in the hospital?
Each patient is assigned a doctor and a primary nurse. Every patient will get to know more than one doctor and nurse, but there will be one primary nurse assigned to that patient. This is part of our care delivery model.

All nursing staff are highly trained and are prepared to provide expert, innovative and responsive care to BMT patients and their families. Each nurse receives a BMT specific training followed by ICU education and competency.  All nursing staff also receive ONS chemotherapy training and are certified in advanced cardiac life support (ACLS). A charge nurse is responsible for each nursing shift. The charge nurse assigns nurses and nursing assistants to each patient. He or she periodically checks with nurses and patients about patient care and can help answer questions and address concerns. Nursing assistants support the nurses by taking vital signs, helping with patient care, and providing for patient comfort needs in the hospital.

Doctors and nurses are only part of our unparalleled BMT team. Every patient and family will also be come into contact with social workers, pharmacists, nutritionists, volunteers, chaplains, etc.  As needed, you may also meet with physical and occupational therapists, speech therapists, etc. We are all here to help you get healthy and through this difficult time as quickly and safely as possible.

Our doctors and researchers are at the forefront of medical science. In addition, the nurses and other members of the BMT Team help ensure that compassion and excellent care are at the center of the patient care experience.

Regular Nursing Care

• A nurse will come into your room to take your vital signs every four hours. They will check your blood pressure, pulse rate, respiratory rate, and temperature. The schedule for checking vital signs is usually 8 A.M., 12 P.M., 4 P.M., 8 P.M., 12 A.M., and 4 A.M. The nursing staff may check vital signs more frequently if your condition changes or if certain medications or transfusions of blood products are given.
• Early each morning, between 4 and 6 A.M., a nurse will draw blood from your central venous catheter. They will only rarely draw blood from your arm. Your blood test results will help determine and guide your care for the day.
• A nurse will also measure your fluid intake and output. You will be asked to save all your urine and stool samples in your bathroom and report the amounts of fluid you drink.
• A nurse will usually do mouth care for you four times each day. This includes cleaning your teeth with toothettes (small sponges) soaked in a salt (saline) solution. You also need to clean your gums, tongue, and cheek pouches. You will rinse your mouth with the solution, spitting after each rinse.
• You will be weighed every morning between 7 and 9 A.M., sometimes twice a day if there is any concern that a patient is gaining or losing too much weight or fluid.
• Your nurse will change your central venous catheter dressings daily or as needed. This depends on the type of dressing, how well the dressing is staying on, dressing cleanliness, and whether the dressing is wet or moist.

Because intensive care requires increased assessment, observation, and patient monitoring, patient rooms may seem less private and more busy. This can make it more difficult for family members to rest in patient rooms. Nursing staff will work with families to promote optimal patient care and family visitation.

Your Daily Routine
Staff members will serve your meals at about 8 A.M., 12 P.M., and 5 P.M. each day. You will receive a menu daily and choose meals for the next day. Dietary staff members are available to help you with menu selections.

You will need to bathe or take a shower every day to reduce the risk of infection.

Physical activity is important to prevent weakness and lung complications. We encourage you to do some physical activity in your room each day to maintain strength and endurance. Exercise bikes and other equipment are available for your use.

We also encourage you to dress in comfortable clothing while in the hospital. Many patients say they feel better psychologically when they are up and dressed every day.

We know that visitors will be very important to you during your stay. However, we allow no more than three visitors in your room at one time. This is necessary to support optimal air quality and patient safety.

Infection Control
During the weeks before your new stem cells produce new blood cells, your body is unable to produce white blood cells. This increases your risk of infection. Our team of doctors and nurses will closely monitor you and give you medicines to prevent infection. You will also be in protective isolation on the BMT unit. While the new stem cells are growing, you will also need transfusions of red blood cells and platelets to replace those they are not yet producing.

To reduce the chance of infection on the unit:

• Anyone entering your room must wash his or her hands with an antiseptic soap for fifteen seconds or use a rinseless degermer (waterless soap).
• Children under age sixteen must have an Infectious Disease Screening Form completed for them before they can enter your room.
• Hospital staff or visitors with signs of a cold must wear a mask at all times on the unit.
• The doors to all patients’ rooms will be kept closed. If a door is held open for more than thirty seconds, an alarm will go off, indicating that the door should be closed to permit continuous air filtration.
• We don't allow any plants—not even dried—in your room. Silk flowers are allowed, but someone must remove any moss at the base of flower arrangements.  Although flowers are a traditional gift, plants and the dirt in which they are potted can carry molds or fungi. That can be harmful to people recovering from BMT.