Treatment before transplant

In the weeks before your blood or marrow transplant (BMT), you will meet with your doctor and other members of your transplant team. During this time, your doctor will check your overall health and disease status to make sure it’s the best time for you to receive a transplant.

You will have a physical checkup before you start the transplant process. This is to make sure that your body is healthy enough to have a transplant.

Physical checkups and tests before transplant depend on your disease and health history. They also may vary from hospital to hospital. Typically, the tests include:

• Heart tests
• Blood tests
• Pulmonary (lung) function tests
• Bone marrow biopsy — This is where a needle is put into your pelvic (hip) bone to take out a small sample of bone marrow.

A doctor studies the marrow under a microscope. Ask your doctor about any tests you don’t understand and make sure you are comfortable with your treatment plan.

Before and after transplant, you will give blood samples, get intravenous (IV) medicines and likely get blood transfusions often. If you don’t already have one, 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 pokes 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 pokes 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. They will also teach you how to protect it when you shower or bathe. 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 transfusions.

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.

The preparative regimen includes chemo given to you through your central line. Sometimes, it also includes radiation therapy.

• 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 2 main types of preparative regimens:

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

The number of days you receive the preparative regiment will depend on the type of regimen. The days you receive the preparative regimen are called "minus" days (or –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. Others can last longer. Your transplant team will treat your side effects and help keep you comfortable. 
 
Some common side effects are:

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

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

The NMDP^SM Patient Support Center provides support, information and resources for transplant patients, caregivers and families.

We are here to help you get reliable, easy-to-understand information from diagnosis through recovery. Call or email us for confidential, one-on-one support from caring experts. We'll listen and help you find answers.