Preparing For Transplant
Preparation for Treatment
After stem cells have been obtained (for an autologous transplant) or a donor has been selected and tested (for an allogeneic transplant), your child will have chemotherapy and possibly radiation. The purpose of high-dose chemotherapy and radiation is to destroy any remaining cancer and bone marrow cells, so the newly transplanted cells have room to grow.
Destroying the bone marrow cells suppresses the immune system, preventing the patient's body from rejecting the transplanted stem cells. This treatment is sometimes referred to as a preparative regimen or conditioning therapy. The preparative regimen most often takes place in the hospital and takes seven to ten days to complete.
Chemotherapy will be given by IV through your child's central venous catheter over several days. The type and amount of chemotherapy depend on the disease being treated, your child's height and weight, your child's age, and their general condition. BMT nurses and nurse coordinators will teach you about the specific chemotherapy drugs that will be included in your child's pre-transplant regimen.
Doses of chemotherapy may be myeloablative or nonmyeloablative. When myeloablative chemotherapy is given, doses are high enough to destroy the bone marrow. Non-myeloablative or reduced-intensity chemotherapy requires somewhat lower doses in select cases. While non myeloablative chemotherapy may be referred to as a "mini-transplant," this is misleading, as recipients are still at risk for significant side effects and post-transplant complications.
The chemotherapy will destroy diseased or cancerous cells, whether they are in the bone marrow or elsewhere. It destroys the normally healthy stem cells in your child's bone marrow as well. It also suppresses, or reduces the strength of, your child's immune system and allows new cells to grow.
Chemotherapy will affect normal fast-growing cells, like those in your child's hair, mouth, stomach, and intestines. Common side effects of chemotherapy include hair loss, nausea, vomiting, diarrhea, loss of appetite, and mouth sores. These side effects are temporary, but some of them may cause mild, moderate, or severe discomfort.
Some of the drugs used in chemotherapy can cause bladder irritation, which may make your child's urine bloody or cause a burning feeling when they urinate.To prevent this, they'll be given fluids intravenously and will be asked to urinate every one to two hours while they're getting this chemotherapy, even through the night.
Some people experience many side effects of chemotherapy, while others have very few. The BMT healthcare team will work with your child to keep them as comfortable as possible. Medications can help with nausea and vomiting. You can help your child by using stress reduction techniques. This might mean listening to calming music, expressing their feelings to someone close to them, writing in a journal, or thinking positive thoughts about how the chemotherapy is fighting their disease.
It's common to feel tired after chemotherapy. Pay attention to what your child's body is telling them and make sure they get enough rest. When your child's immune system is suppressed, their energy level is lower and they are more susceptible to infections.
Radiation may be given along with chemotherapy to destroy diseased or nonfunctioning cells and suppress the immune system. Three types of radiation are used in preparation for a BMT. Depending on the disease being treated, your child may receive one of the following:
- Fractionated total body irradiation (TBI) -- radiation directed at your child's whole body in a series of doses, where each dose is a "fraction" of the total
- Total lymphoid irradiation (TLI) -- radiation directed specifically at the lymph system
- Single-fraction total body irradiation (TBI) -- radiation directed at the whole body in a single dose
- Total Marrow Irradiation (TMI) - radiation directed precisely to the bone marrow
Radiation therapy is not painful, but your child has to hold very still while it is being given. Each session of irradiation takes five to ten minutes. Children may be given sedation or anesthesia if they are too young to stay still on their own. Family members may go with your child to the radiation therapy department, though no one is allowed in the room with your child during the radiation treatment.
Short-term side effects of radiation treatment may include nausea and vomiting, diarrhea, hair loss, increased and thickened saliva, lowgrade fever, mild jaw pain, and skin rashes. Your child's healthcare team will help your child manage these side effects.
Getting a Central Venous Catheter
At some point during the pre-transplant process, your child will have a thin tube called a central venous catheter (CVC) or right atrial catheter (RAC) inserted. The catheter makes it possible for the medical team to draw blood; give drugs, fluids, and nutritional supplements; collect stem cells; transfuse blood products; and transfuse the stem cells on your child's transplant day.
Placement of the catheter is usually done on an outpatient basis in an operating room or radiology procedure room at the hospital. The catheter will be left in throughout the transplant process. You and your child will be taught how to care for the catheter to prevent it from becoming infected or clotted.