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Steps: Transplant

Shortly before the transplant procedure, the patient's health is evaluated again and a central intravenous line is inserted. The central line is used for the preparative regimen and the transplant.

1. Administer the preparative regimen

Before the patient can receive the donated hematopoietic cells, a preparative regimen destroys the patient's diseased or cancerous cells. The physician chooses the preparative regimen based upon the disease status and the patient’s health.

A myeloablative regimen usually includes chemotherapy to destroy most of the cancer cells often followed by total body irradiation. During this regimen, the patient must be hospitalized.
A non-myeloablative or reduced-intensity regimen uses smaller doses of chemotherapy and a lesser strength of radiation, or no radiation. A reduced-intensity regimen:
- Is more effective with some diseases than others
- Is less toxic so more patients are eligible for a transplant, such as older patients and patients who have co-morbidities
- Is sometimes performed as an outpatient treatment

During the preparative regimen, which can last from 4 to 10 days on average, the bone marrow is partially or completely destroyed. During this time, the patient is at risk for infection, anemia, bruising and bleeding. Patients also experience short-term side effects that can be managed with medication and other treatments.

2. Transplant (infuse) the hematopoietic cells

One or two days after the preparative regimen is completed, the cells are transplanted. The donated cells, contained in a blood bag, are usually infused through a central line.

3. Monitor engraftment of the hematopoietic cells

During the first several weeks after infusion, the patient is in isolation or a HEPA-filtered room to minimize infections. Daily blood samples are taken to check when the donated cells start to grow and multiply (engraft).

The patient may also receive:

Platelet transfusions
Filgrastim (granulocyte-colony stimulating factor or G-CSF), a synthetic human protein, to make more blood cells
Total parenteral nutrition (TPN), to provide calories, nutrition and fluid when a patient cannot eat

If engraftment does not occur within 14 to 30 days, the patient may receive additional treatments or a second transplant.

Usually the patient leaves the hospital within the first 100 days after transplant. Depending upon the requirements of the transplant center, the patient may need to visit the outpatient clinic daily, or on a regular basis, until his or her blood count reaches a specific level.

Patients may be interested to learn about:

Transplant day (marrow.org)
Measuring engraftment (marrow.org)
Waiting for engraftment (marrow.org)

Steps: Transplant

On this page:

1. Administer the preparative regimen

Related Link:

2. Transplant (infuse) the hematopoietic cells

3. Monitor engraftment of the hematopoietic cells

Related Links: