Bone Marrow Transplant |
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Bone Marrow Transplant
 Preparation
Procedure
Recovery
Preparation On this page is an overview of the preparation process for a bone marrow transplant. For more details, please see:
Initial Consultation
There is a lot involved to first decide whether a bone marrow transplant (BMT) is the best option for your child and second to prepare your child for the transplant. The process begins with an initial consultation, where you and your child will meet with various members of the bone marrow transplant team.
Your child's history will be reviewed and potential donors discussed. Additional blood studies may be obtained in order to complete the tissue typing. We will review with you and your family the basic issues of the bone marrow transplant and answer any questions that you might have. For some diseases there also may be evaluations such as developmental testing and a consultation with other specialists.
Pre-Transplant Work-Up and Evaluation
Following the initial consultation, a decision is made by both you and the doctors as to the feasibility and desirability of going ahead with the transplant. If the decision is to move forward, your child will have a work-up and evaluation. This will assess your child's medical and psychological status with respect to his or her ability to undergo a transplant. The work-up will include a thorough medical evaluation, including various tests to assess your child's overall health and the state of his or her condition. The timing of this work-up typically takes place a few weeks prior to the transplant. If an unrelated donor search needs be performed or if your child needs additional treatment, then the work-up will be delayed until a transplant date is set.
Informed Consent Conference
Following the pre-transplant evaluation you and your family will have an informed consent conference. You will meet with a bone marrow transplant doctor, nurse, social worker and other members of the health care team to review the results of the pre-transplant evaluation and the treatment plan, and discuss the benefits and risks of a transplant. The consent forms are documents that review the essential purposes and procedures of the bone marrow transplant, as well as the risks and benefits. Signing the consent form indicates that everyone understands as much as possible about what is involved in the bone marrow transplant process and agrees that it is the best treatment available. The consent conference is recorded so that you can share this information with other family members or review it again. In addition, you may invite other family members or friends to the consent conference.
Before Admission
Prior to entering the BMT Unit, your child will require the insertion of a special intravenous catheter, which is a special type of intravenous line (IV) central venous catheter throughout the entire transplant process and helps avoid the pain and discomfort of multiple IVs and blood draws.
The catheter is inserted in the operating room. Some children already may have had this operation in order to facilitate treatment of their disease. While under general anesthesia, the catheters are inserted into major blood vessels in the neck and exit the skin on the front of the chest or abdomen.
In addition to the catheter, your child may require one or more of the following:
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Collection of peripheral blood bone marrow stem cells (PBSC), which is required for cancers such as lymphoma, neuroblastoma, sarcomas, primitive neuroectodermal tumors (PNET) and Wilms' tumor
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Bone marrow stem cell harvest, which is required when a PBSC collection is not possible or is inadequate
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Busulfan pharmacokinetic study, which is required if your child will be receiving busulfan as part of the conditioning regimen
Admission to the BMT Unit
The average stay in the hospital is six to eight weeks and sometimes longer. The adjustment to being away from home and getting comfortable with the hospital can take a while, but it's easier when you know what to expect. Please see Coming for a Bone Marrow Transplant to find packing tips and suggestions for keeping the entire family involved in the transplant process.
Upon admission to the BMT Unit, a countdown period of usually five to 10 days begins. Day 0 marks the end of the countdown and the day of transplant. During the countdown period, one of the conditioning regimens is administered. This involves treatment with chemotherapy agents and possibly radiation, called total body irradiation.
Immediate relatives are encouraged to spend time with the patient while he or she is hospitalized for a bone marrow transplant. However, there are a few rules that must be followed. Please see Rules for Visiting the BMT Unit for details.
Daily Care
There are several routines that are done daily or several times a day to minimize those problems that may occur during the bone marrow transplant process. This includes:
- Bathing with a special soap
- Mouth care techniques to reduce the severity of mouth sores
- Specific procedures to care for the catheter
- Using ointments to prevent the skin on the buttocks from becoming irritated after bowel movements
Oral and Intravenous Medications
Antibiotics and medicines are given throughout the transplant period to reduce irritation of the stomach and intestines and prevent certain kinds of infections that frequently occur in a transplant recipient.
For more details, please see:
Reviewed by health care specialists at UCSF Children's Hospital.
Last updated May 8, 2007
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