The Transplant Process
At Miami Valley Hospital (MVH), cancer patients may be referred to the Blood and Marrow Transplant Program in different ways. Usually, an oncologist or hematologist makes the referral, but the patient or a family member may initiate the process.
The cancer treatment involves the administration of high doses of chemotherapy and/or radiation followed by the infusion of previously collected blood marrow or stem cells. Throughout the transplant process, a dedicated team of highly trained specialists coordinate patient care.
The process of blood and marrow transplantation usually takes three to four weeks and consists of the following steps:
- Patient interview and pre-transplant evaluation
- Peripheral blood stem cell collection and/or blood marrow harvest
- High-dose chemotherapy and/or radiation
- Infusion of stem cells
Patient Interview and Pre-transplant Evaluation
MVH cancer patients meet with the transplant team members who provide specific information about the transplant process, and initiate and assist with the third-party payor process.
Transplantation therapy begins with a thorough evaluation to determine the patient’s current state of health. Eligible MVH cancer patients must meet general transplant-screening criteria.
Many laboratory tests and x-rays are done to determine the status of the patient’s disease. Tests include blood chemistries, infectious disease titers, a bone marrow aspiration (using a needle, a small sample of bone marrow is removed from the hip for examination under a microscope), chest x-ray, electrocardiogram (EKG), CT scans, a pulmonary (lung) function test, and a nuclear medicine scan (heart).
Peripheral Blood Stem Cell Collection and/or Bone Marrow Harvest
A stem cell (also called mother cell) is an immature blood cell located in the bone marrow and the peripheral blood. As the stem cell grows, it matures into a red blood cell, white blood cell, or platelet.
For a peripheral blood stem cell transplant, the stem cells are collected from the blood during an outpatient procedure. A central line/catheter is inserted into a vein in the upper chest area during a surgical procedure. The catheter is a small, flexible tube that is used to collect the blood, which is processed by a blood cell separation machine. This painless procedure is called an apheresis collection. Generally two to four collections are needed to obtain enough stem cells for the transplant. The patient’s stem cells are then processed and stored until chemotherapy and/or radiation treatments are finished.
For an autologous blood marrow transplant, the stem cells are collected or harvested from both pelvic (hip) bones during a surgical procedure with a needle and syringe. No incisions are made. General anesthesia is used for this relatively simple procedure that takes about two hours. The patient’s marrow will be processed, frozen, and stored until chemotherapy and/or radiation treatments are completed.
High Dose Chemotherapy and/or Radiation
After the peripheral blood stem cells and/or bone marrow have been collected, patients are hospitalized for the third phase of the treatment process.
Cancer patients stay in the Blood and Marrow Transplant Unit (BMTU) in MVH. The unit is specially equipped with the most effective technology, including a High-Efficiency Particulate Air (HEPA) filtered air system to reduce the risk of infection. All rooms are private with individual bathrooms. (Please, no plants or flowers are allowed on the unit.)
High-dose chemotherapy used alone or in combination with total body irradiation is given over two to eight days, depending upon the oncology patient’s type of cancer. High doses of radiation or chemotherapy temporarily destroy the patient’s immune system and blood-forming (hematological) system. The immune and blood system recover approximately two weeks after the stem cells and/or marrow are infused.
Infusion of Stem Cells
The previously collected stem cells and/or bone marrow are reinfused approximately 24 to 48 hours after completion of the high-dose therapy. The frozen stem cells and/or marrow is brought to the MVH cancer patient’s room, thawed, and given intravenously like a blood transfusion. The infusion or “transplant” takes one to two hours.
After infusion, the stem cells and/or marrow travel through the blood stream and find their way into the empty bone marrow spaces. Once in place, they grow, divide, and begin to produce new red blood cells, white blood cells, and platelets. This process is called engraftment.
During this time, the patient is susceptible to infection and bleeding caused by low blood counts until the marrow or stem cells complete the engraftment process. To prevent this from happening, the patient receives blood and platelet transfusions and multiple antibiotics. Once the bone marrow engrafts and is producing a sufficient number of healthy red blood cells, white blood cells, and platelets (usually two to three weeks), the patient is discharged from the hospital.
Learn more about what to expect with blood and marrow transplant.