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 to reduce anxiety and stress.

Phases of Bone Marrow Transplant:

A bone marrow transplant is not a single-day procedure; it has many phases. In each phase patient needs proper care and guidance.

The following are the three main phases of bone marrow transplant:

• Preparatory Phase ( screening and human leukocyte antigen (HLA) matching)
• Transplant Phase (conditioning chemotherapy started, and stem cells or bone marrow cells are infused)
• Post-Transplant Phase / Recovery Phase (patient starts recovering from the transplant phase)

Preparatory Phase and role of transplant coordinator:

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 an Electrocardiogram and echocardiogram. It will check the proper functioning of the heart.

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

Your Kidney function will be assessed by a renal function test, and this is very crucial to keep the kidneys safe from the adverse effects of medications used during the conditioning phase specially the chemotherapy drugs.

Moreover, the kidneys could be saved by maintaining a proper hydration status. This can be done by encouraging oral fluid intake or administering intravenous fluids.

Respiratory Fitness: (by a Pulmonologist)

 Similarly, it will assess you through some tests like “PFTs (Pulmonary function test and HRCT (High-Resolution 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”.

Infectious Disease Clearance: (Phases of Bone Marrow Transplant)

The patient is screened for infections in the pretransplant period. The screening is done in the blood, urine, and stool to rule out any kind of infectious disease. In case of any active infection, it is necessary to treat the infection before moving the patient to the transplant phase.

Admission of Patient to Bone Marrow Transplant Unit

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

Central Line Insertion: Phases of Bone Marrow Transplant

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

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

Conditioning phase ( High dose Chemotherapy and radiation administration)

• The patient will be given high-dose Chemotherapy or sometimes Radiotherapy.
• The purpose of this high-dose Chemotherapy is to kill the existing marrow and create a vacant space for the 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 minus days start from the first day of chemotherapy administration.

THE PHASES OF BONE MARROW TRANSPLANT: DAY (0)

Moreover, day 0 or the transplant day counts when the stem cells /bone marrow are infused through a central line. After the transplant patient has to stay in the hospital for about 2 -3 weeks until the new marrow settles in the patient’s bone marrow and starts to produce new cells.

During these two weeks, the patient may experience the following symptoms:

• Weakness (feeling of low energy)
• Low white blood count (makes the patient suseptable for infections).
• Also, Low platelets (may need platelet transfusion). This may increase the risk of bleeding.
• Low hemoglobin level (may need packed RBC transfusion). In this condition patient experiences low energy level and shortness of breath, which may further lead to drowsiness and lethargy.
• Deranged electrolytes (replacement of the altered electrolytes can be carried out.
• Fever (can be treated with 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. The wellness of the patient after transplant depends on the care, especially the personal hygiene and hygienic food.

Moreover, it is recommended to stay away from sick people and crowded places to keep save and avoid getting infected.