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'll check into 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 will 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 correctly. It also suppresses your body's immune system so that it won't attack the new stem cells after the transplant. Some people may get more than one cycle of chemotherapy before 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 relieve these symptoms.

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

Your immune system will be very weak after this treatment, and you can easily get an infection. As a result, you'll stay in a hospital room that has special features, such as filtered air, to keep the room as clean as possible.

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

Preparation before a stem cell 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

A stem cell transplant is like a blood transfusion. During the procedure, you'll get donated stem cells through your central line. Once the stem cells are in your body, they will travel to your bone marrow and begin making new red blood cells, white blood cells, and platelets.

You'll be 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 they'll 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 will take an hour or more. This includes the time to set up the procedure, do the transplant, and check you afterward.

Recovery in the Hospital

You'll 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 and/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'll check your blood counts every day to track your progress.

You'll stay in the hospital until your immune system recovers and your 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, infections, graft-versus-host disease, and graft failure.

Having support from family and friends, especially having someone who can be with you most days in the hospital, can help you recover.

Side Effects From Chemotherapy or Radiation

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

Side effects include:

• Painful sores in the mouth.
• Nausea, diarrhea, and intestinal cramps.
• Skin rashes.
• Hair loss.
• Liver damage. This side effect occurs in about 10 percent of people who go through the transplant preparation.
• Interstitial pneumonia. This type of pneumonia 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 methods to treat these side effects. Some go away on their own once your blood cells begin to grow and your immune system recovers.

Infections

You can easily get infections after the transplant because your immune system is weak. Infections can be serious and may 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'll stay in a private room. The air will be filtered to keep germs out. Doctors, nurses, and others who visit you will wear face masks and carefully wash their hands. 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, such as:

• Bathing or showering daily
• Carefully cleaning your teeth and gums
• Cleaning the area where your central line enters your body
• Avoiding foods that may have harmful bacteria, such as raw fruits and vegetables

Graft-Versus-Host Disease and Graft Failure

Donated stem cells can attack your body. This is called graft-versus-host disease (GVHD). Your immune system also can attack the donated stem cells. This is called graft failure.

GVHD and graft failure can be minor or life threatening. They can happen soon after transplant, or they might develop slowly over months.

For more information about these complications, go to "What Are the Risks of a Blood and Marrow Stem Cell Transplant?"

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