The Transplant Process
The transplant process can take time, and includes the conditioning regimen to prepare the patient, the transplant itself, and the engraftment period.
The Conditioning Regimen
Once a donor has been found and medically cleared, the patient undergoes a conditioning regimen to destroy the diseased cells and the entire immune system, to ensure that the body does not attack the healthy new cells it is about to receive. This can take one of two forms: myeloablative (MY-ello-uh-BLAY-tiv) or non-myeloablative.
Myeloablative transplant involves the use of chemotherapy and/or radiation therapy. The choice of these and how to balance them depends on many factors, so the best treatment regimen for each patient is created by the physician and the transplant center.
Non-myeloablative transplant is a reduced-intensity treatment that relies in part on the patient’s own immune system to fight the disease. This method may be an option for older patients.
Ready for transplant
With the conditioning regimen completed, the patient is ready to receive the transplant of either bone marrow or peripheral blood stem cells. The donated cells are infused into the patient through an IV line, and on their own will find their way through the body into the bone marrow to begin creating healthy blood cells and a new immune system. This process is called engraftment.
The engraftment can take several weeks, as the donated cells get settled in and start their work. This is often when patients experience the most discomfort, as they have no immune system to protect them, and side effects of chemo or radiation therapy may emerge. With the engraftment process underway, blood is taken frequently to look for indications that the transplant cells have taken hold, with new blood and immune system cells being formed. It can be a frustrating wait, as the patient must remain in a clean isolation room to prevent infections.
Graft vs. Host Disease
One of the conditions that the physician will monitor for during engrafment is graft vs. host disease. It can occur if the donated cells perceive the recipient’s cells as foreign and attack the recipient’s body. Areas that can be affected include the skin, eyes, liver, and gastrointestinal tract. The physician will discuss strategies with the patient to increase comfort and minimize the risk and severity of this, and other, side effects.
Continue to next section, About Transplant Recovery.