If you are considering a blood or bone marrow transplant, it’s important to get your questions answered beforehand. We encourage you to review some of the most common questions our Moffitt team members are often asked.
What special preparations will I need to undergo before the transplant?
You will need to have a central venous catheter (central line) inserted into your chest, which stays in place throughout the transplant process. This will provide access to major veins for receiving chemotherapy, antibiotics, intravenous nutrition, and medications that are needed throughout the transplant process. The catheter may also be used for drawing blood most of the time. The central venous catheter requires specialized care. Members of the Moffitt Transplant team will provide this care in the hospital and teach you and your caregiver to maintain it after discharge from the inpatient or outpatient transplant unit.
Will I need any additional medical tests before the transplant?
You will be screened before the transplant to help the medical team assess your physical condition and determine whether your current health can withstand the procedure. This will include an assessment of the heart, lungs, kidneys and liver, as well as other tests which may be done to further evaluate your condition. You will be required to have a dental evaluation before the transplant to ensure there are no infections in the gums or roots of the teeth. You may also undergo other tests through the use of radiographic tools (x-rays, CT scans, MRI, bone scans, and PET scans) or bone marrow biopsy to measure the extent of your disease.
Will I have to stay in the hospital?
Depending on the type of transplant and your overall condition, your doctor will recommend whether hospitalization is necessary at all. We have a large outpatient transplant program that provides daily care and is available to any of our patients. In this case, the patients will still be required to stay within 15 minutes of Moffitt Cancer Center. If you have your transplant as an inpatient, while in the hospital, you will be cared for in a specialized nursing unit where the nurses and other personnel are specially trained to recognize, treat, and prevent the side effects that transplant patients may experience during the procedure. You will be staying in a private room with every precaution made to protect you from infection during your stay.
Can I have visitors during the transplant?
Yes, you will be able to have visitors though they will be required to report to the nursing station and thoroughly wash their hands. Visitors with a cold or any other infection will not be allowed in the bone marrow transplant (BMT) units or the clinics. Children under 12 are not permitted on the inpatient BMT units or in the BMT Clinic or Treatment Center without special permission from the BMT attending physician. Due to the COVID-19 pandemic, visitation policies may be modified to account for higher rates in the community.
What are the requirements for a caregiver?
A transplant will require a primary caregiver, who can be a family member or friend who will be caring for you 24 hours a day after your discharge from the transplant unit until you return home. Some patients also choose two or more caregivers to share responsibilities.
How long will I need to stay in Tampa?
You and your primary caregiver will be required to remain in the Tampa area following the transplant until you are sufficiently stable to return home. For patients receiving an autologous transplant with their own stored blood or marrow stem cells, that may mean one month; for those receiving stem cells from another donor, that time period is about three months. Our Psychosocial Oncology team is available to discuss and arrange offsite housing for you and your caregiver.
Moffitt has also partnered with nearby hotels to provide accommodations for our patients and their family.
What is HLA typing?
Human leukocyte antigen (HLA) typing uses laboratory tests to look for specific antigens found on the surface of human white blood cells. These antigens are known as the HLA Class I and Class II antigens. For allogeneic transplants (using bone marrow from another person), these tests are used to help determine the extent to which a donor and recipient are a match. Your doctor will use this information to choose the best donor for the transplant.
How are stem cells collected?
Stem cells are most commonly collected for transplant from circulating (or peripheral) blood. When stem cells are removed from the peripheral blood, the patient or the donor is treated with a medication called granulocyte colony-stimulating factor (GCSF) to make the stem cells emerge from the bone marrow and into the bloodstream. They are then connected to an apheresis machine, which separates white cells from the blood. The remaining blood components (the red blood cells, platelets, and serum) are returned to the patient. It is a fairly painless procedure that takes about eight hours a day repeated daily until an adequate number of stem cells have been collected. For patients, this takes anywhere from one to three days; for donors, usually one to two days.
In special cases that are identified by the transplant physician, stem cells are collected from the bone marrow, a one-hour procedure called marrow harvest, during which marrow is drawn from the patient/donor's hipbone. Marrow harvests are done in the operating room, usually under general anesthesia to ensure that the patient/donor will experience no pain when the marrow is withdrawn. Most patients/donors are released the same night.
What is a conditioning regimen?
Conditioning is designed to treat your disease and to prepare your body for a transplant, and usually includes chemotherapy alone but may also include total body radiation treatments (TBI), or other immunosuppressive medications. It can take anywhere from three to six days to administer, depending on the chemotherapies used.
How are stem cells transplanted?
For an autologous stem cell transplant (donor provides his or her own stem cells), the patient’s frozen stem cells are thawed and infused into the patient immediately through their central line. For an allogeneic transplant (from a related or unrelated donor), stem cells are either collected at Moffitt or at another center and then transferred from the donor center to Moffitt. The processing laboratory performs a stem cell count, removal of plasma or red cells if specified, and any other selection processes deemed necessary. Eventually, they are delivered to the patient’s bedside where they are immediately infused. The stem cell transplant usually takes one to two hours in most cases, with the patient monitored for an allergic or other reaction the entire time.
What are the possible side effects of a stem cell transplant?
You may experience some side effects as a result of your stem cell transplant, as well as some unanticipated ones. Therefore, you will be monitored closely throughout the entire transplant period and receive special therapies prior to, during and following the transplant to minimize and treat these side effects, which may include:
- Suppression of the bone marrow:
- White blood cells will drop very low. There is a risk of infection and the need to use antibiotics.
- Need for transfusion of red blood cells
- Risk of bleeding and need for transfusion of platelets
- Sores in the mouth and throat(mucositis)
- Diarrhea and irritation of the intestinal tract
- Nausea and vomiting
- Difficulty eating, and need for intravenous nutrition
- Electrolyte abnormalities
- Weakness, fatigue, malaise (feeling bad)
- Rashes and other skin changes
- Hair loss
- Possible damage to the heart, lungs, liver, kidney, bladder or other organs
- Rejection or failure of the stem cells to grow
- Graft-versus-host disease, a reaction of the donor immune system against the recipient's organs
- Infertility (temporary or permanent)
- Numbness and tingling of the extremities
- Hearing loss
- Eye discomfort and changes in vision sometimes requiring changes in eyewear prescriptions
- Death, though the risk of dying from a transplant depends on each patient's unique characteristics, diagnosis, and type of transplant being performed
What is graft-versus-host disease?
A unique complication for allogeneic transplants (stem cells from another person, including either a related or unrelated donor) is graft-versus-host disease (GVHD). Acute GVHD occurs soon after the transplant when growing donor stem cells recognize the recipient as foreign and begin attacking the patient's own cells, often resulting in a rash, diarrhea or hepatitis (inflammation of the liver).
Risk is dependent upon the degree of matching between the patient and donor, the age and gender of both the patient and donor and conditioning regimens. Chronic GVHD happens beyond three months from transplant and can affect the skin, eyes, mouth, muscles/joints, lungs, intestines, or liver. For serious GVHD, additional medications may be given to treat and control the complications.
What precautions will I need to take once I have undergone a transplant?
Following the transplant, you will be required to follow special guidelines given to you at discharge by the Moffitt Transplant team as a precaution to decrease your risk of infection and other complications. These include:
- Following a special diet
- Minimizing contact with others and avoiding crowds with potential sources of infection
- Avoiding plants, exotic animals and sick pets
- Delaying return to work until permitted by your transplant physician
- Avoiding sun exposure if you had an allogeneic transplant and always using sunscreen
- Adhering to any limitations given regarding sexual activity.
What about recurrence?
Recurrence is one of the most frequently identified fears of patients who have undergone a transplant. The Moffitt team regularly monitors patients for recurrence through the use of bone marrow biopsies, blood tests and radiology tests such as CT scans and bone scans. If the cancer recurs, your team will determine the best steps and possibly other treatments. In many cases, cancers that recur after a transplant can still be cured with further treatment.
Most cancers recur in the first two to three years, although some can return years later. Patients can work with social workers on staff and attend support group meetings to talk with others facing similar recurrence fears. The use of special Integrative Medicine Program services, such as yoga, massage, tai chi and acupuncture, can also help alleviate stress.
The best things you can do as a cancer survivor is to keep complete records of your care information, including surgeries, pathology reports and provider contact information; show up for all necessary follow-up appointments; and commit to whatever post-treatment care plan has been laid out to support survivorship. With a solid survivorship program in place and your commitment, the Moffitt team can help you cope with these real and warranted fears and keep regular testing measures in place to help prevent a recurrence.
Medically reviewed by Hany Elmariah, MD, MS