Treatment ​steps ​before ​a blood stem cell ​transplant

When preparing for your peripheral blood stem cell (PBSC) or bone marrow transplant (BMT), you’ll meet with your doctor and transplant team for a health checkup. Testing may include reviewing your medical history, blood and organ function tests, a physical and a bone marrow biopsy.

The results of your checkup play a part in what treatment steps your doctor will recommend leading up to your transplant.

No matter what type of treatment you receive before your transplant, you’re never alone. Whether you’re looking for personal, spiritual, or group support, our Patient Support Center is available to help you understand your transplant journey.

Before your transplant, you'll undergo a series of tests and blood work to ensure your body is healthy enough for a stem cell transplant. Based on your specific needs your doctor may not recommend every test listed below, but most patients can expect to go through several of them to help prepare for transplant.

Heart testing before your transplant may include things like an electrocardiogram (ECG), which checks your heart’s rhythm, and an echocardiogram, which provides imaging of your heart and the surrounding blood vessels.

Prior to transplant, your care team will perform blood tests to check your blood cell levels and see how well your liver and kidneys are working.

Your doctor may ask to perform a lung function test before your transplant to check how well your lungs are working. This is often done by measuring how much air you can breathe in and out, and how quickly you can do it.

During a biopsy, your doctor will collect a small sample of your bone marrow by placing a needle into your pelvic (hip) bone and studying the marrow under a microscope.

If at any point during your pre-transplant treatment you feel unsure or don't understand the testing your doctor is advising, it's important to take the time and speak with your transplant team. They will be able to address any concerns or answer questions about every test you're being asked to complete.

Before and after transplant, you will give blood samples, get intravenous (IV) medicines and likely get blood transfusions often. You will have a central venous catheter, or central line, put in before your transplant to ease this process.

A central line is a small tube that's put into the large vein in the chest or neck, just above the heart. It makes it easier to give you medicines, blood transfusions and take blood samples. It also lowers the number of needle sticks you'll need.

Some patients may already have an implanted port. This is a type of central line where the catheter is completely under the skin. A nurse inserts a needle through your skin to connect to the implanted port. Your doctor will tell you if the port is okay for your transplant or if a central line is also needed.

It's important to keep your central line and the skin around it clean and dry to prevent infections. Your transplant team will teach you and your caregiver how to keep it clean when you’re at home, including while showering and bathing. It's also important that you never use scissors near your central line.

Tell your doctor if you see any signs of infection around your central line. Some signs of infection include:

• Fluid draining around where the tube enters your body
• Pain, redness or swelling along the tube under your skin
• Chills after flushing the line
• Fever

A central line will be used throughout the treatment process for many reasons, such as getting IV medicines and blood stem cell transfusion.

Before you get your blood stem cells, your doctors need to prepare your body to receive them. This is called the preparative regimen or conditioning regimen. The preparative regimen is the chemotherapy (chemo) and radiation you get in the days right before your transplant.

This is an important part of your pre-transplant treatment because the chemo and radiation will:

• Destroy as many of the diseased cells that are left in your body as possible
• Weaken your immune system to help keep your body from rejecting the donated cells after transplant

There are two main types of preparative regimens to help prepare your body for transplant, allogeneic and autologous. The biggest difference between them is how strong the treatments are. Your transplant team will choose the approach that's safest and most effective for you.

Allogeneic regimens are used when you’re receiving a transplant from a donor. There are two types of allogeneic preparative regimens:

Standard-intensity regimen: Uses high doses of chemo, with or without high doses of radiation. Also called a myeloablative regimen.

Reduced-intensity regimen: Uses a lower dose of chemo, with or without lower doses of radiation. Also called a non-myeloablative regimen.

Your doctor will choose the type of preparative regimen for you based on your disease and overall health.

Autologous regimens are used when you're receiving your own previously collected stem cells. For this type of transplant, you get higher doses of chemo ,with or without radiation, than you would get if you weren't getting a transplant. The higher doses may cause more severe side effects, but they also destroy more diseased cells.

The number of days you receive the preparative regiment chosen by your transplant team will depend on the type of regimen. The days you receive the preparative regimen are called "minus" days (you may also see it written as "–days"). Some patients may receive the regimen for an entire week while others may only receive it for a few days. This part of the transplant process is the "countdown" to "Day Zero," the day you receive the new cells from your donor.

You will likely have side effects from your preparative regimen. Some may last a few days, while others can last longer. Your transplant team will treat your side effects and help keep you comfortable.

Some common side effects you may experience as a result of chemotherapy or radiation include:

• Fatigue (feeling tired)
• Nausea
• Vomiting (throwing up)
• Diarrhea
• Lack of appetite
• Mouth sores
• Hair loss
• Skin rash

You may have other side effects that occur within the first month after beginning the preparative regimen. Your transplant team will watch you closely and care for you throughout your recovery after transplant.