Autologous Transplant — Getting Ready for a Bone Marrow Transplant

Most bone marrow transplant patients are still admitted to the hospital for the entire transplant procedure, which means about a two- to three-week hospital stay. There is a trend for patients to receive some of their treatment as outpatients and to be admitted only in the event of a complication. The Rush Bone Marrow Transplant Center, like most good bone marrow centers, has HEPA-filtered air in its patient rooms, which ensures that air contaminants are removed from the room. We also filter the air of the entire transplant ward so patients are not confined to their rooms.

The combination of drugs and/or radiation before transplant is called the conditioning regimen. For patients undergoing other forms of transplant or treatment, doses are limited because of the damage they can cause to the bone marrow. In an autologous bone marrow transplant, however, patients can be given five to ten times the standard dose because the bone marrow cells have been removed from the body. What limits giving, say, 100 times the normal dose? Too high a dose can cause severe damage — or toxicity — to organs such as the heart, liver and lungs. Therefore, autologous transplant allows larger doses of anticancer therapy, but the amount is limited to what is safe for the patient.

The type of preparative regimen depends on the type of cancer. Some cancers respond very well to radiation, so radiation is given to the whole body in a procedure known as total body irradiation. Radiation treatment is like getting an X-ray, but the amount of radiation given is obviously much greater. In most cases, six doses or fractions of radiation are given over three days. The lungs are more sensitive to radiation than the rest of the body, so they are shielded for one dose. Most people tolerate radiation treatment well. Radiation can cause nausea and mouth ulcers, but these usually occur several days after the treatment is completed.

Radiation treatment is always given with at least one chemotherapy drug. If no radiation is given, then several different drugs are combined. The high-dose chemotherapy is given through a central line. When the drugs are being given there may be some nausea, but this can usually be controlled with anti-nausea drugs, which have improved dramatically over the past few years.