What To Expect During a Blood and Marrow Stem Cell Transplant

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

Preparation

You will 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 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 6 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 properly. It also suppresses your body's immune system so that it won't attack the new stem cells after the transplant.

The high doses of chemotherapy and radiation can cause side effects, including nausea (feeling sick to your stomach), vomiting, diarrhea, and tiredness. Medicines can help with these symptoms.

In older patients or those who aren't very strong, doctors may choose "reduced-intensity" treatment. This involves lower doses of chemotherapy or radiation.

Because your immune system is very weak after this treatment, you can easily get an infection. As a result, you will stay in a hospital room that has special features that keep the room as clean as possible.

Doctors, nurses, and visitors also have to wash their hands carefully and follow other procedures to make sure you don't get an infection. For example, they may wear a face mask while in contact with you.

Preparation before a transplant may take up to 10 days. The time depends on your medical situation, general health, and whether you need chemotherapy or chemotherapy and radiation.

Transplant

During the transplant, which is like a blood transfusion, 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 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 will 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 or radiation you got before the transplant.

Your doctors will test your blood 7 to 10 days after the transplant to see whether new blood cells have begun to grow. They will check your blood counts every day to track your progress.

You will stay in the hospital until your immune system recovers and 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, and graft-versus-host disease (GVHD) and graft failure.

Side Effects From Chemotherapy or Radiation

The chemotherapy and possible radiation you get before the transplant have side effects. These side effects begin to appear a few days after the transplant. Some of these side effects are painful or uncomfortable; others are very serious. They include:

• Painful sores in the mouth.
• Nausea, diarrhea, and intestinal cramps.
• Skin rashes.
• Hair loss.
• Liver damage. This occurs in about 10 percent of people who go through the transplant preparation.
• Interstitial pneumonia. This is a kind of pneumonia that affects certain tissues in the lungs. It affects about 5 percent of people who go through the transplant preparation.

Doctors use mouth rinses, medicines, and other treatments to treat these side effects. Some go away on their own once your blood cells begin to grow and your immune system recovers.

Infection

You can easily get an infection after the transplant because your immune system is weak. Some infections are serious. Infections can be caused by:

• Bacteria, such as those in your mouth or around your central line
• Viruses, such as herpes or cytomegalovirus
• Fungus or yeast, such as candida

To prevent infections, you will stay in a single room. The air will be filtered to keep germs out. Doctors, nurses, and others who visit you will wear face masks and wash their hands very carefully. Your doctor may have you take medicine to fight infections even if you don't already have an infection.

You also can take other steps to prevent infections.

• Bathe or shower daily.
• Carefully clean your teeth and gums.
• Keep the area clean where your central line enters your body.
• Avoid foods, such as raw fruits and vegetables, that may have harmful bacteria.

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.

GVHD and graft failure are described more fully in "What Are the Risks of a Blood and Marrow Stem Cell Transplant?"