Bone Marrow Or Stem Cell Transplantation

What is a stem cell transplant?

• A stem cell transplant is a procedure where stem cells are put into your blood. Stem cells are found in bone marrow (spongy tissue inside bone), blood, and the umbilical cords of newborns. The umbilical cord is attached to a baby's abdomen and brings nutrition to a child before he is born. Stem cells are able to become other cells, such as red blood cells (RBCs) or white blood cells (WBCs). RBCs help deliver oxygen to all parts of your body. WBCs help fight infection caused by germs. Once stem cells are transplanted into your blood, they travel to your bone marrow and start growing into new cells.
  
  
• Your cells may become damaged from cancer or cancer treatment, such as chemotherapy (chemo) or radiation. Cells also may become damaged by non-cancer diseases, such as sickle cell anemia or problems with your immune system. Your immune system is the part of your body that fights infection. When new stem cells enter your body, they may turn into healthy cells that replace damaged cells. New cells may help decrease the symptoms from your disease or treatment, such as fatigue (feeling very tired). Healthy cells may help kill cancer cells and you may be less likely to get your cancer again.

What are the types of stem cell transplants?

The type of transplant that you have is based on who donates the stem cells. You may have any of the following:

• Autologous transplant: If you have an autologous transplant, your own stem cells will be removed through a procedure called harvesting. Your stem cells may be frozen and then thawed when it is time for the transplant. Your stem cells also may be transplanted into your body right after harvesting. An autologous transplant is often used for cancers such as lymphoma, leukemia, and breast cancer.
  
  
• Allogeneic transplant: If you have an allogeneic transplant, the donor is someone who may or may not be related to you. A person from a bone marrow or stem cell bank may be willing to donate their stem cells to you. Both you and your donor are tested before the procedure to see if your cells match. Your donor's stem cells are harvested and frozen until your transplant. An allogeneic transplant is often used to treat bone marrow cancer or other bone marrow diseases.
  
  
• Syngeneic transplant: In a syngeneic transplant, you receive stem cells from an identical twin.

What happens before a stem cell transplant?

• Before a stem cell transplant, you may receive cancer treatment, such as chemo, radiation, or both. These treatments help kill cancer and other damaged cells. Chemo and radiation also may help stop your immune system from attacking the new transplanted cells.
  
  
• If you are having an autologous stem cell transplant, you will have your own blood harvested a couple of weeks before your transplant. During bone marrow harvesting, stem cells are taken from bone marrow removed from your bones. During peripheral blood stem cell harvesting, your stem cells are removed from blood taken from a vein (blood vessel). Ask your caregiver for more information about stem cell harvesting.

What happens during a stem cell transplant?

Your caregiver will put a central line (tube) into your body. The central line is put into a large vein (blood vessel) near your collarbone, in your neck, or in your groin. The groin is the area where your abdomen meets your upper leg.

• If the stem cells are frozen, they will be thawed and put in your body through the central line. If your stem cells are harvested right before your transplant, your central line will be attached to a machine. During harvesting, this machine will remove stem cells from your blood or bone marrow. Before your transplant, harvested stem cells will be checked for infection and cancer. RBCs will be removed from bone marrow to help stop your immune system from attacking your new stem cells. Your stem cells will be transplanted into your body through the central line. Stem cell harvesting and the stem cell transplant may take several hours.
  
  

What are the risks of having a stem cell transplant?

• Your body may reject the new stem cells. You may get graft-versus-host-disease (GVHD). GVHD may cause you to have stomach pain and nausea (feeling sick to your stomach). You may also vomit (throw up) or have diarrhea (loose, watery stools). You may get engraftment syndrome, which causes you to gain weight and have a fever, rash, and diarrhea. You may get sores inside your mouth. You may be unable to have sex or create a baby. You may lose too much blood and you may need a blood transfusion. Your immune system may not work as well as before the transplant, and you may get a serious infection.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• If you have your own stem cells transplanted back into your body, the cells may have cancer in them. These cancer cells may spread to other parts of your body. One or more of your body organs may become damaged, such as your lungs, heart, brain, kidneys, and liver. Liver problems may cause your skin to turn yellow. Brain damage may cause you to have a seizure (convulsion) or have trouble thinking clearly. You may have a heart attack, a stroke, or trouble breathing, and you may die. Without a stem cell transplant, your condition may become worse and you may die. Call your caregiver if you have questions or concerns about your condition, transplant, or care.

What hand washing safety measures may I take to help prevent an infection?

Use warm, soapy water to wash your hands frequently. Your caregiver may tell you that it is okay to clean your hands using antibacterial hand rub. Wash your hands before or after the following:

• After touching your mouth or nose.
  
  
• After touching or being near bowel movements.
  
  
• After changing diapers.
  
  
• After touching dirt, such as when gardening or touching plants.
  
  
• After going outdoors.
  
  
• Before and after touching wounds (sores) on your body.

What cooking safety measures may I take to help prevent an infection?

There are several cooking safety measures that you may take to help decrease your chances of getting an infection. These safety measures include:

• Wash your hands with warm, soapy water before eating and preparing food.
  
  
• Keep raw meat (such as beef and poultry), fish, and seafood on separate surfaces than other foods. Do not use a cutting board that has already touched raw foods. Wash your hands and cooking tools (such as knives) after touching raw foods.
  
  
• Cook all meat thoroughly so that it is not rare. Never eat rare meat. When in a restaurant, order all meat well done. Do not eat rare or undercooked eggs. Avoid salad dressings and other sauces that may contain undercooked eggs.
  
  
• Wash all fresh produce (such as fruits and vegetables) thoroughly under running water.
  
  
• Carefully clean your kitchen, including your counters, shelves, and refrigerator.
  
  
• When preparing leftovers, put small portions in separate containers. Refrigerate all leftovers within two hours or throw them away. When reheating leftovers, make sure that they are reheated completely, inside and out. If reheating soup, make sure that it comes to a rolling boil and boils for at least one minute.
  
  
• Ask your caregiver if a special diet, such as a low microbial diet, is right for you.

What drinking safety measures may I take to help prevent an infection?

It is important that you do not drink tap water. Tap water comes from a faucet, such as in your kitchen or bathroom. Do not use tap water even when brushing your teeth. If you must drink tap water, you must bring it to a boil and then keep it boiling for at least one minute. You also may be able to use a filter for your tap water. Ask your caregiver for tap water instructions that are right for you. Other drinking safety measures include:

• Do not drink from private or public water wells.
  
  
• Do not have drinks made from frozen concentrates, such as juices.
  
  
• Make sure that all milk or orange juice that you drink has been pasteurized. Milk and orange juice containers will be marked if the drinks have been pasteurized. Do not drink milk or orange juice unless it came from a sealed container.
  
  
• Avoid drinking sodas, coffee, or other drinks in restaurants and movie theatres. Ask your caregiver which drinks are okay for you, such as bottled or canned soda.

What personal care safety measures may I follow to help prevent an infection?

After your stem cell transplant, you will need to use safety measures while you take care of yourself. After your transplant, do not put anything into your rectum (anus). Other safety measures include:

• Bathing and showering: Take a shower or bath every day. Use a mild soap. After showering or bathing, look at your skin for sores or signs of inflammation (redness and swelling).
  
  
• Going to the bathroom: Do not use outhouses or portable toilets. Avoid public toilets. If you are female, always wipe from front to back after going to the bathroom. Do not use tampons.
  
  
• Sex: Use latex condoms during sex to help prevent sexually transmitted diseases (STDs). Follow your caregiver's instructions for safely having sex.

What animal safety measures may I take to help prevent an infection?

Being around a pet or other animals may increase your risk of getting an infection. If possible, you should try to avoid direct contact with animals, such as petting. Your caregiver also may want you to do the following:

• Wash your hands after you touch your pets or other animals.
  
  
• Ask someone else to clean litter boxes or cages. If you must clean a litter box or cage yourself, wear gloves and wash your hands afterwards. Do not put a litter box near where you eat or prepare food, such as your kitchen or dining room.
  
  
• Do not allow your pet to drink from the toilet.
  
  
• Take your pet to his veterinarian (vet) for regular checkups. Do not adopt or touch stray or sick pets.
  
  
• Do not touch reptiles (such as lizards) or primates (such as monkeys or gorillas).
  
  
• Avoid going near chicken coops or other places where birds may roost.
  
  
• Feed your pets only high quality food. Cats should only have canned or dry food. If you cook your pets' meals, cook all food thoroughly so that it is not rare.
  
  
• Keep your cats inside your home. Avoid letting your cats outside.

What people and places should I avoid to help prevent an infection?

After a stem cell transplant, you should avoid being around certain places and people. Your caregiver may give you the following instructions to help prevent infection:

• Avoid being around people who are sick or have a rash.
  
  
• Avoid crowded places, such as malls and elevators.
  
  
• Avoid going to places that may have dirt that has been dug up, such as farms and construction sites.
  
  
• Do not go into a pond or lake.
  
  
• Do not go to another country unless your caregiver says it is okay.
  
  
• If someone you know has recently had a vaccine, ask your caregiver when it is okay to be near that person again.

What safety measures may my friends and family members take to help prevent me from getting an infection?

Your family members should get vaccines for certain illnesses, such as influenza (flu). All sexual partners should be tested for STDs. If someone else is cooking for you, he should follow your caregiver's instructions for touching and preparing food.

When should I call my caregiver?

Call your caregiver if:

• You have stomach pains, nausea, vomiting, and diarrhea.
  
  
• You have a fever (high body temperature), gain weight, or get a rash.
  
  
• You have a faster heart rate than normal, even at rest.
  
  
• You have sores, swelling, or redness in your mouth.
  
  
• Your skin or the whites of your eyes turn yellow.
  
  
• You have a cough that does not go away.
  
  
• You have blood in your stool or urine.
  
  
• You have chest pain or trouble breathing that is getting worse over time.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You have a seizure.
  
  
• You suddenly feel lightheaded and have trouble breathing.
  
  
• You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.
  
  
• Your arm or leg feels warm, tender, and painful. It may look swollen and red.
  
  
• You have one or more of the following. These signs and symptoms may happen suddenly:
  
  
  • A very bad headache. This may feel like the worst headache of your life.
    
    
  • Too dizzy to stand.
    
    
  • Weakness or numbness in your arm, leg, or face. This may happen on only one side of your body.
    
    
  • Confusion and problems speaking or understanding things.
    
    
  • Not able to see out of one or both of your eyes.
    
    
  • This is an emergency. Call 911 or 0 (operator) for an ambulance to get to the nearest hospital. Do not drive yourself!

Where can I get support and more information?

Having a transplant may be a life-changing event. You may feel depressed (very sad) and anxious (very worried) about what may happen during or after the transplant. These feelings are normal. Talk to your caregiver, friends, and family about your feelings. You also may contact any of the following:

• Blood and Marrow Transplant Information Network, BMT InfoNet
  2310 Skokie Valley Road, Suite 104
  Highland Park , IL 60035
  Phone: 1- 888 - 597-7674
  Web Address: http://www.Bmtnews.org
  

• National Marrow Donor Program
  3001 Broadway Street NE, Suite 100
  Minneapolis , MN 55413-1753
  Phone: 1- 888 - 999-6743
  Web Address: http://www.marrow.org
  

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.