Phases of Bone Marrow Transplant (Patient Information)

The Bone Marrow Transplant is a complex procedure and requires patients and their families to have a clear understanding of the steps and phases involved. It is important to explain the process to patients and their loved ones in order to reduce anxiety and stress.

Phases of Bone Marrow Transplant:

The following are three main phases of bone marrow transplant:

• Preparatory Phase
• Transplant Phase
• Post-Transplant Phase / Recovery Phase

Preparatory Phase:

Upon receiving advice from a physician regarding a bone marrow transplant, the patient will be recommended to undergo a transplant workup. The transplant coordinator will work with the patient and their family to coordinate the process. The coordinator will also discuss the cost of the transplant, the duration of the hospital stay, and arrangements for blood and blood products during the transplant phase. In countries where blood banks do not provide significant support, the family will need to arrange for blood products such as platelets and packed RBCs for the patient.

Additionally, the transplant coordinator will be present during the pre-workup phase. The workup will include HLA (human leukocyte antigen) testing for allogeneic transplants. This test is done to find a matched donor for the patient, especially siblings in countries where a matched unrelated donor registry is not approved by the government. Both the patient and the donor will be advised to undergo a fitness workup before selecting a donor. the donor will be advised to undergo a fitness workup before selecting a donor. the donor will be advised to undergo a fitness workup before selecting a donor.

All Systemic Fitnesses Include:

 Cardiac Fitness. (By consulting a Cardiologist)

A cardiologist will assess you through your physical history and some standard tests like Electrocardiogram, and echocardiogram. It will check the proper functioning of the heart.

Renal (kidney) fitness: (by consulting a Nephrologist).

Your Kidney function will be assessed by renal function test.

Respiratory Fitness: (by a Pulmonologist)

 Similarly, it will assess you through some tests like “PFTs (Pulmonary function test and HRCT (high resonance chest Tomography” to check your lung functioning).

However, patients will also be assessed for any infection in the body for which blood, urine, and stool culture testing will be done. As soon as the pre-transplant workup is done and all cleared, the transplant coordinator will issue a memo to all concerned departments, including dates from the admission till the day of the transplant called “Zero”.

Admission of Patient to Bone Marrow Transplant Unit

Moreover, the patient is admitted to the bone marrow transplant unit, the transplanting phase starts with the following steps.

Central Line Insertion:

The central venous catheter will be inserted, which will be used for the following purposes.

• Intravenous fluid administration.
• Medication administration.
• Chemotherapy administration.
• Blood and blood product transfusions.
• Stem cells /bone marrow infusion.
• Also, blood sampling.
• Sometimes can also be used for nutrition called TPN (total parental nutrition).

Conditioning phase (Chemotherapy administration)

• The patient will be given high-dose Chemotherapy or sometimes Radiotherapy.
• The purpose of this high-dose Chemotherapy is to finish the existing marrow and create vacant space for newly transplanted marrow.
• To kill some remaining cancer cells.
• To suppress the immunity of patients to avoid rejection of new stem cells.

The days of conditioning depend upon the chemotherapy regimen selected by the transplant consultant. These days normally count as – (minus day e.g.  -7, -6, -5 ….-1 and day “0 “).

THE PHASES OF BONE MARROW TRANSPLANT: DAY (0)

Furthermore, The stem cells /bone marrow are infused on transplant day through a central line. After the transplant patient has to stay in the hospital for about 2 -3 week till the new marrow settles in the patient’s bone marrow and start to produce new cells.

During these two weeks, the patient feels the following symptoms:

• Weakness (feeling of low energy)
• Low white blood count (makes patient risky for infections).
• Also, Low platelets (may need platelet transfusion).
• Low hemoglobin level (may need packed RBC transfusion).
• Deranged electrolytes (replacement will be done).
• Fever (can be treated through antibiotics).
• Diarrhea /vomiting.
• Mucositis/ oral ulcers (may vary from grade 1 to grade 4).

Recovery Phase /Post-Transplant Phase

After a minimum of two weeks, the transplanted marrow begins to produce new cells. However, once it reaches its peak level, the patient’s recovery process commences, and the transplant physician recommends discharging the patient with home medications and specific instructions related to diet and exercise. This involves taking short courses of antibiotics, anti-fungal, anti-viral, and immunosuppressive medication to minimize the risk of rejection in an allogeneic bone marrow transplant. It is crucial to provide post-transplant care to achieve optimal results.