A bone marrow transplant (also called a stem cell transplant) is used to treat certain types of blood cancers (such as certain leukemias, myelomas, and lymphomas). If you have a type and stage of cancer that is best treated with a bone marrow transplant, we encourage you to consult with our team at the Fox Chase-Temple University Hospital Bone Marrow Transplant Program. During your initial consultation, you will meet with several members of our multidisciplinary bone marrow transplant team:

• Our oncologist will ask you for your medical history, review your medical records from your referring physician, and discuss treatment options with you. Some of the specific questions you may be asked include those about your general health, past blood transfusions, exposure to radiation, and past or current infections.
• Our medical assistant or registered nurse will draw your blood to help determine your current health status.
• Our financial coordinator will discuss treatment expenses, your insurance coverage, and your options for additional transplant costs.
• Our transplant coordinator, a registered nurse specially trained in the care of bone marrow transplant patients, will answer your questions and provide you with specifics about our program. They are there to support and educate you in whatever way you need.
• Other members of your team will include certified nurse practitioners, physician assistants, nurse navigators, and social workers.

We know that undergoing a bone marrow transplant is a significant decision and often marks the beginning of a long and challenging journey for our patients. Our transplant program staff members strive to provide comprehensive and compassionate support throughout every phase of the transplant process, and we will be alongside you throughout your entire treatment journey.Before Your Transplant

Before Your Transplant

You will undergo various testing procedures. Typical pre-transplant tests, arranged by your transplant coordinator, include:

• Pulmonary function tests to assess the health of your lungs
• An echocardiogram to assess your heart function
• Laboratory studies to assess your kidney and liver function
• A bone marrow biopsy to assess the status of your cancer

The pre-transplant studies are usually completed in one week. Once you finish all your testing, you will have a meeting with your transplant coordinator and your physician to go over your results and discuss the process of moving forward with your treatment.

At this appointment, you will receive a transplant schedule that looks similar to a wall calendar. This helps our patients and family members visualize the steps leading up to their transplant. You will also be asked to sign a written informed consent document.

Your transplant coordinator will remain your point of contact every step of the way until your admission to the hospital for your transplant and will ensure that you have the support you need before returning home. If you have any questions or concerns in the time leading up to your treatment, your transplant coordinator will be happy to assist you.

Types of Bone Marrow Transplants

The type of transplant you receive will be determined by several factors, including your diagnosis, the stage of your disease, your overall health, and your age.

For an allogeneic transplant, healthy bone marrow cells come from matched donors who may or may not be related to you. To identify a donor for you, our team will determine if a relative is a match or will work with the National Marrow Donor Program to find an unrelated match. The timing of allogeneic transplants depends on the proper identification and availability of a donor.

Autologous transplants infuse your own healthy bone marrow cells (which are collected ahead of time) back into your body. In order to gather these cells, you will receive medication that enables your body to make more stem cells than needed. The excess stem cells are then collected from your body for the transplant.

The Transplant Process

When patients hear the term “transplant,” they may think of an operation. However, bone marrow transplants are not a surgical process. Stem cells are given back to the body in the same manner as a blood transfusion (the cells are pushed into IV tubing, travel back to the bone marrow, and start to make a new population of healthy blood cells).

Before your transplant, you will be admitted to our bone marrow transplant clinic, which is a dedicated unit with inpatient rooms that offer advanced safety precautions.

All patients have single rooms with a patient-to-nurse ratio of 2:1 for close monitoring. The rooms are equipped with special air filters to significantly decrease your risk infection, and all personnel are required to wash their hands and wear masks at all times to protect patients. In addition, patients are started on antiviral, antifungal, and antibacterial medications before their transplants to help prevent them from developing systemic infections.

The first step of your treatment will be a preparatory (or conditioning) regimen, which may include high doses of chemotherapy and/or radiation. This will kill the cancer cells in your body and suppress your immune system.

After this stage of treatment, you will receive the transplant of stem cells that have been collected from you or your donor.

After Your Transplant

During the weeks following your transplant, it will take time for the new cells to function in your body. This will increase your risk of infection. Depending on your transplant type, it may take weeks for your new stem cells to begin producing enough blood cells to protect your body.

Because of this, you will need to stay in protective isolation in our inpatient unit for a certain time after getting your transplant. To prevent infection, you will receive several medications and will be closely monitored in our clinic.

Depending on your progress and the type of transplant you received, our team will determine when you are ready to go home. It is important to note that all patients recover at their own pace, and each type of transplant has a different standard recovery period.

After you return home, your care team will continue to track your health and recovery. Although response to treatment can be seen much sooner, patients typically undergo response evaluations two to three months after their transplant. If you are determined to be in remission, your long-term follow-up care will typically include regular follow-up visits and testing.

Multiple Transplants

There are some instances in which a patient may need more than one bone marrow transplant:

• Some patients may receive maintenance therapy after their first transplant to keep their cancerous cells at a low level for as long as possible. However, if their cancerous cells reach a certain level again, they will need to undergo a second transplant.
• Other patients may receive two autologous transplants within three months of one another to maximize their chance of going into remission.
• Patients with certain types of lymphoma who relapse after an autologous transplant may be treated with an allogeneic transplant.

These situations will be planned for in advance and closely monitored by the physicians within our program. Our patients will be kept informed of the next steps of their care at every stage of their treatment.

Support Services

Undergoing a bone marrow transplant is a difficult experience not only for you as the patient, but also for your caregivers and loved ones. The time-intensive process requires serious commitment and an understanding that there may be a long road to recovery with difficult side effects. Because of this, it is important to have a strong support system by your side.

The staff members in our program are acutely aware of this, and we offer various support services to help you and your family deal with the emotional, physical, and social challenges that often come with the transplant journey. As one of our patients, you will have access to:

• A complete team of clinicians who will monitor your health closely before, during, and after your transplant
• Interventional radiologists who will assist with placement of indwelling catheters
• Licensed social workers who work closely with patients, caregivers, and loved ones to support them before, during, and after the transplant process
• A board-certified psychiatrist who specializes in psychopharmacology (the study of the effects medications have on mood, thinking, and behavior)
• A certified nutritionist to help with dietary issues during and after your treatment
• Palliative care, which focuses on improving quality of life for patients and their families through the management of symptoms, pain, and stress brought on by serious illness

Our bone marrow transplant team will be by your side during every step in your treatment journey and will work to provide you with any resources you need for support. We are here for you.