Making the decision to receive a blood or marrow transplant (BMT) and preparing for the procedure may feel overwhelming with the various steps involved and the time commitment needed to complete treatment.
You’ll likely have many questions about the logistics of being in the hospital away from home or work for weeks or even months. You’ll need caregivers to help you when you return home, and you’ll follow a special diet for people with weakened immune systems.
The BMT experts at the OSUCCC – James understand these concerns and will make sure you stay informed and have everything you need throughout the transplant process. Our team consists of nurse transplant coordinators, social workers, physical therapists, dieticians, mental health providers and others to help make your BMT experience as seamless as possible.
When you need a blood or marrow stem cell transplant, the Blood and Marrow Transplant Program at the OSUCCC – James is the clear choice for expert, comprehensive and compassionate care.
Preparing for a blood or marrow transplant
In the weeks leading up to your transplant, you’ll be assigned a transplant coordinator and meet with the many members of your transplant team. During these appointments, we’ll help you plan for your transplant. Together, we’ll work on:
- Finding a donor – If you need a donor (allogeneic) transplant, we’ll work with you, your family and the National Marrow Donor Program to locate a donor. We’ll test people to find the best possible match.
- Financial assistance – Our social workers will help you determine what insurance will cover and what will be out-of-pocket expenses. Often, there is assistance available, including stipends for housing.
- Fertility preservation – The high doses of chemotherapy and radiation given before the transplant can often affect fertility. If you think you might want biological children, we can discuss freezing eggs or sperm.
- Lodging – People who live further away from the OSUCCC – James will have to make accommodations to live nearby for several weeks or months while receiving treatment and recovering. We have lodging partners in the area to assist with this.
- Caregiving – To devote your full attention and energy to recovering, you’ll need to designate a caregiver to help you with daily tasks throughout recovery.
The last step before the actual transplant will be conditioning, or the chemotherapy or radiation you’ll receive to prepare your body for the transplant.
Navigating chemotherapy and radiation before a BMT
People who receive a stem cell transplant receive high doses of chemotherapy or radiation to kill or weaken cancer cells and suppress the immune system to accept transplanted stem cells.
Chemotherapy, with or without radiation, is administered starting up to seven days before the transplant, either in the hospital or daily at our outpatient location. You may experience side effects including nausea, fatigue, headaches or mouth sores.
To minimize side effects, our BMT specialists will:
- Give anti-nausea medications and other drugs
- Encourage you to be out of bed often, as physical activity is important to recovery
- Support you in maintaining adequate nutrition
- Help you maintain proper hygiene to minimize mouth sores and other infections
- Listen to your needs and any changes you experience
How to make a hospital stay for a blood or marrow transplant easier
After your transplant infusion, you’ll remain in the hospital for several weeks (unless you’re receiving your care at our Outpatient Bone Marrow Transplant and CAR T-Cell Program). This allows us to monitor you and care for you while engraftment occurs. Engraftment happens when the newly transplanted cells enter your bone marrow and start making new cells, which is the goal of BMT.
This can be a challenging time, but we’ll try to make your stay as comfortable as possible while tending to your recovery and any complications.
Here are some tips to avoid complications and make your hospital stay a bit easier:
- Stay active as much as possible
- Practice breathing exercises every two hours while awake
- Clean mouth four times a day
- Shower daily and use waterless bath cloths after
- Invite visitors when feeling up to it, but those who are sick should avoid visiting; masks and handwashing are required
- Have a fresh change of clothes for each day
- Bring shoes or slippers with good treads for walking
- Use FaceTime, Skype or other messaging apps to stay in contact with loved ones
- Bring a new toothbrush and other toiletries that will make you feel comfortable
- Follow the immunocompromised diet if you bring food from home, and try to get enough calories daily to maintain strength
While there are restrictions in place, remember that they’re to keep you safe and to give you the best chance at a successful transplant.
Going home after a blood or marrow transplant
To be discharged from the hospital following a stem cell transplant, you’ll need to meet certain requirements. The length of stay will depend on a variety of factors including the type of transplant you had, your overall health before the transplant and how long it takes you to meet these criteria.
Criteria for discharge include:
- White blood counts have returned to near normal
- You’re free of infection
- You can stay hydrated on your own
- Any nausea and diarrhea are controlled
- Activity levels have increased, including being able to dress, bathe and feed yourself
- Any complications have been resolved
- A caregiver is ready to help you at home
Even after returning home, you’ll have to follow certain protocols to further your recovery.
Infection prevention
Even after returning home, your immune system is still weakened, so you’ll need to take extra precautions to prevent infection. Tips for doing so include:
- Wash hands often, especially after visitors or handling pets
- Avoid cleaning up after pets and facial contact with pets
- Don’t handle plant soil as it is a risk for fungal infection
- Have caregiver pay special attention to cleaning bathroom surfaces
- Make sure visitors practice good hygiene and avoid visits when they feel sick
- Practice food safety, such as washing produce, storing food properly and throwing away food if uncertain of safety
Nutrition
You’ll remain on the immunocompromised diet until roughly 100 days post-transplant or until you no longer need to take immunosuppressant medications (steroids or tacrolimus). We’ll provide more information on foods to avoid and safe measures to take.
After leaving the hospital, you’ll want to make sure you avoid drinking well water, using public drinking fountains and eating at buffets, salad bars or sample stations.
Follow-up appointments
After discharge, you’ll need to return to the James Hematology and Transplant Clinic regularly for tests to ensure the success of the transplant. If you live more than one hour away, we’ll ask you to stay in a local apartment until about 100 days after your allogeneic transplant. We have partners who can assist with finding a place to stay.
A typical follow-up schedule might look like this:
- Return to the clinic twice a week for the first few weeks after discharge and at least weekly until about 100 days after your allogeneic transplant
- Decrease visits from there as needed, usually at least once every month or two for the first year
- Evaluate ongoing need for the central venous line starting at day 60
- Plan a return-to-work date with your physician, usually waiting at least six months following transplant
Mental health care
Going through the BMT process can take a huge mental toll. Fortunately, the OSUCCC – James has services and programs, including support groups and psychotherapists specializing in cancer and transplant patients, in place to help you manage any mental health issues.
If you’re feeling symptoms of depression or anxiety or another mental health condition, talk to your doctor or other transplant team members about your symptoms. Feeling healthy mentally can help aid your recovery physically.
How long will it take me to recover after a blood or marrow transplant?
When you’re discharged from the hospital or are no longer required to visit the outpatient program daily, we hope that you’ll be feeling more like yourself; however, full recovery from a blood or marrow transplant often takes six months or more. Over those months, you’ll have regular appointments with your transplant team.
While we want to monitor your well-being, we also want to see how your body is responding to the transplant. Once you’re 100 days post-transplant, you’ll become part of our Long-Term Follow-Up Clinic. In this clinic, we’ll review long-term transplant complications, including chronic graft-versus-host disease, and discuss preventative maintenance to increase the potential longevity of the transplant.
Preventative measures include:
- Pulmonary function tests
- Bone density scans
- Vaccinations
- Routine lab work
- Secondary cancer screenings
Related resources
Blood and Marrow Transplant Program
Blood and Marrow Transplant Types
Blood and Marrow Transplant Treatment
Stem Cell and Bone Marrow Donation
Blood and Marrow Transplant Research
Outpatient Bone Marrow Transplant
Blood and Marrow Treatment Team