leukemia / bone marrow transplant (bmt) program of british ...€¦ · the new marrow and prevent...

TransplantModule

Patient Education Manual

Leukemia / Bone Marrow Transplant (BMT)Program of British Columbia

Leukemia/BMT Inpatient Unit (T15A) Reception/Unit Clerk 604-875-4343

Leukemia/BMT Daycare Outpatient Unit (CP6 A/B) Reception/UnitClerk604-875-4073•Afterhours,calltheInpatientUnit604-875-4343

Cell Separator Unit – CSU (CP6 C) Reception604-875-4962•BookingClerk604-875-4626 AfterHourscallLocatingandaskfortheCSUnurseordoctoroncall604-875-5000

BMT Doctor(writeyourdoctor’snumberinhere)__________________________________

BMT Coordinators BrankaDeutsch(unrelated) 604-875-4831 CarolynFrew 604-875-4111,local67486 JanetBury(unrelated) 604-875-4111,local67485 MaryChan 604-875-4939 SheilaWong 604-875-4111,local63432 ValerieCampbell 604-875-4111,local68549 Fax 604-875-5678or604-875-4910

Social Workers T15InpatientUnitOffice 604-875-4941 CP6DaycareOutpatientUnitOffice 604-875-4697

Pharmacist 604-875-4077

Occupational Therapist 604-875-4343

Nutritionist 604-875-4343

Physiotherapist 604-875-4343

Leukemia/BMT Program Administration Office 604-875-4863

Medical Services Plan of BC and Fair Pharmacare 604-683-7151or1-800-663-7100

Leukemia/BMT Inpatient Unit (T15A) Reception/Unit Clerk 604-875-4343

Leukemia/BMT Daycare Outpatient Unit (CP6 A/B) Reception/UnitClerk604-875-4073•Afterhours,calltheInpatientUnit604-875-4343

Cell Separator Unit – CSU (CP6 C) Reception604-875-4962•BookingClerk604-875-4626 AfterHourscallLocatingandaskfortheCSUnurseordoctoroncall604-875-5000

BMT Doctor(writeyourdoctor’snumberinhere)__________________________________

BMT Coordinators BrankaDeutsch(unrelated) 604-875-4831 CarolynFrew 604-875-4111,local67486 JanetBury(unrelated) 604-875-4111,local67485 MaryChan 604-875-4939 SheilaWong 604-875-4111,local63432 ValerieCampbell 604-875-4111,local68549 Fax 604-875-5678or604-875-4910

Social Workers T15InpatientUnitOffice 604-875-4941 CP6DaycareOutpatientUnitOffice 604-875-4697

Pharmacist 604-875-4077

Occupational Therapist 604-875-4343

Nutritionist 604-875-4343

Physiotherapist 604-875-4343

Leukemia/BMT Program Administration Office 604-875-4863

Medical Services Plan of BC and Fair Pharmacare 604-683-7151or1-800-663-7100

Contents

Introduction 1TransplantBasics 2TypesofBlood&MarrowTransplant ........................................................................................ 2

Whatarestemcells? ................................................................................................................ 2

Howarestemcellscollected? .................................................................................................. 3

Specific Section for Autologous Transplant Patients 5VeinAssessment 6WhattoExpect ......................................................................................................................... 6

G-CSFAdministration 7FrequentlyAskedQuestions-FAQs ........................................................................................ 7

TheCollectionofPeripheralBloodStemCells 9WhattoExpect ......................................................................................................................... 9

SideEffectsDuringtheApheresisProcedure ........................................................................... 9

FrequencyofStemCellCollections ........................................................................................ 10

ProcessingtheStemCellCollection ....................................................................................... 11

StorageofStemCells .............................................................................................................. 11

WhentoCalltheDoctor 11ImportantReminders 11

Phases of BMT: Autologous & Allogenic Transplants 13Pre-BMTPhase 14DiagnosticTests ...................................................................................................................... 14

Hickman®LineInsertion ......................................................................................................... 14

ConditioningTreatment .......................................................................................................... 15

BMTPhase 17TheTransplantProcess ........................................................................................................... 17

SideEffects .............................................................................................................................. 17

Post-BMTPhase 19Engraftment ............................................................................................................................ 19

Graft-Versus-Host-Disease(GVHD) ....................................................................................... 19

ManagingLowWhiteCellCounts .......................................................................................... 21

ManagingLowRedCellCounts .............................................................................................. 22

ManagingLowPlateletCounts ............................................................................................... 22

Transfusions ............................................................................................................................. 24

Discharge 24Whenarepatientsdischarged? ............................................................................................... 24

PreparationsforDischarge ..................................................................................................... 25

DischargeChecklist ................................................................................................................ 26

BMTDay100(3-Month)Evaluation 27

Introduction

WehaveputtogetherthisTransplantModuletohelppatients,theirfamiliesandcaregiverslearnabout

blood andmarrow transplantation.There aremany caring and knowledgeable peopleon your

healthcareteamtohelpyouthroughthetransplant,addressyourconcernsandansweryourquestions.

Pleasedonothesitatetospeaktothem!

Blood andmarrow transplantation is a treatment formany diseases in both adults and children. Bone

marrowisthespongytissuefoundinsideyourlargebonesandisresponsibleformakingbloodcells.These

bloodcellsincludeyourplatelets,whitebloodcellsandredbloodcells.Thebonemarrowisalsohometo

theimmunesystem.Allofthesecellsareveryimportant,soachangeinmarrowfunctioncanhaveserious

sideeffects.

Thetermbloodandmarrowtransplant,orBMT,hasbeenusedformanyyears.Youare,however,likely

tohearsomedifferentterms.Allofthesefallintothecategorycommonlydescribedasbloodandmarrow

transplant.Someofthesetermsare:

• Peripheralbloodstemcelltransplant

• Bloodstemcelltransplant

• Bloodprogenitorcelltransplant

• Bloodstemcellandbonemarrowre-infusion

Thedifferenceinthesetermshastodowithwhatisactuallytransplantedandwherethecellscomefrom.

YoucanreadmoreaboutthisinTransplantBasicsinthenextsection.

Forsimplicity,bloodandmarrowtransplant,orBMT,willbethetermusedhereforalltypesofbloodand

marrowtransplant.Aswell,thetermsbonemarrowandstemcellswillbeusedinterchangeably.

Introduction

Therearefour

typesoftransplant:•Autologous•Allogenic

•VolunteerUnrelated•Syngeneic

L/BMTPatientEducationManual•TransplantModule

Transplant Basics

Types of Blood & Marrow TransplantBloodandmarrowtransplantorBMTisusedtotreatavarietyofdiseasebutitsbasicpurposeisthesame.

BMT is used to replace amalfunctioning or non-functioning bonemarrowwith a healthy, functioning

marrow.

Before the transplant, patients undergo conditioning treatmentwith chemotherapy and/or total body

irradiation(TBI).Thisconditioningtreatmentisusedtoeliminatetheunderlyingdisease,createspacefor

thenewmarrowandpreventrejectionofthenewbonemarrow.Followingtheconditioningtreatment,

patientsundergoBMTtorestorehealthybonemarrowfunctioning.

Therearedifferenttypesoftransplantsdependingonwhodonatesthebonemarroworbloodstemcells.

Theyare:

1. Autologous Transplant. The patients donate their own stem cells prior to

treatmentforre-infusionlater.

2. Allogeneic Transplant. Stem cells are donated from an acceptably matched

familymember(usuallyabrotherorasister)oranunrelateddonor.

3. Volunteer Unrelated Transplant.Stemcellsaredonatedbysomeonewhois

notrelatedtoyou.TheanonymousdonorisfoundintheCanadianorworldwide

donorregistries.

4. Syngeneic Transplant.Thepersondonatingthestemcellsisan

identicaltwin.

YourBMTdoctorwilldiscussindetailwhattypeoftransplant

isrecommendedforyou.

What are stem cells? Bloodcellsgrowinthesamewayasotherhuman

cells.Theydevelopinthebonemarrowfroma

parentcellknownasastemcell.Stemcellsare

immaturecells thatcandevelop intoallof the

differenttypesofbloodcells:whitebloodcells,

redbloodcellsandplatelets.Stemcellsareusually

2 33

foundinsidethebonemarrowspacesoflargebones.Theycanalsotravelfromonebonetoanotherby

wayofthebloodstream.

Inabloodandmarrowtransplant,stemcellsareharvested,eitherfromthelargebonesorfromtheblood

stream,andtransplantedtothepatient.Stemcellscollectedfromthepelvicboneinthelowerbackare

calledbonemarrow.Stemcellsharvestedfromthebloodintheveinsarecalledperipheralbloodprogenitor

cells.Thisiswhybloodandmarrowtransplantsareoftenreferredtoasbloodstemcelltransplants.For

simplicity,wewillusethetermsbonemarrowandstemcellsinterchangeablyinthismanual.

YourBMTdoctorwilldiscusshowstemcellswillbecollectedfromyouoryourdonor.

How are stem cells collected?Therearetwodifferentmethodstocollectstemcells.

1.Peripheral Blood Stem Cell Collection. Stem cells can be collected from

the blood. This procedure is called a peripheral blood stem cell collection.

This technique does not require surgery. It does, however, involve a few

moresteps thanaconventionalbonemarrowharvest.Prior to thecollection,

the donor or autologous transplant patient is given amedication to promote

thegrowthandreleaseof stemcells fromthebone into theblood.Thestem

cells are then collected using a special machine called a Cell Separator. This

techniquehasdramaticallyincreasedinpopularityoverthelasttenyears.Stem

cells are generally collected using this method here at the Leukemia/BMT

ProgramofBC.

2. Bone Marrow Harvest.Stemcellscanbecollecteddirectlyfromthebonemarrow

spaces,mostoftenfromthepelvicbones.Severalpuncturesitesaremadealong

theboneandthecellsareremovedusinganeedle.Thisprocedureisknownasa

bonemarrowharvest.ThistechniqueisusedlessoftenhereattheLeukemia/BMT

ProgramofBC.

TransplantBasics2 33

Notes

L/BMTPatientEducationManual•TransplantModule 4


Specific Section for Autologous Transplant

Patients

4


Autologoustransplantreferstostemcellsorbonemarrowthatarecollectedfromthepatientand

thengivenback(re-infused)tothesameindividualinthetransplantprocess.Thisrequiresthepatient

toundergoeitherabonemarrowharvestoraperipheralbloodstemcellcollection.

Thissectionprovidesanin-depthlookatwhatis involvedinaperipheralbloodstemcellcollectionfor

autologoustransplantpatients.

Peripheralbloodstemcellcollectionforautologoustransplantpatientsinvolvesthefollowingsteps:

1.Veinassessment

2.G-CSFadministration

3.Actualcollectionofperipheralbloodstemcells

Vein Assessment

What to ExpectAveinassessmentisnecessarytoensurethatthepatienthasstrongveinswithgoodbloodflowforthe

bloodstemcellcollectionprocedure.

AnappointmentwillbemadeforyoutogototheVancouverGeneralHospitalCellSeparatorUnit,also

referredtoastheCSU.TheCSUislocatedattheKrallCentreonthe6thflooroftheCentennialPavilion.

OnyourfirstvisittotheCSU,youwillbegivenatouroftheunit.Theprocessofstemcellcollectionwill

beexplainedandshowntoyou.

Anursewillcheckyourarmveinslocatedintheelbowareatoensurethattheycanbeusedforthestem

cellcollectionprocedure.TheCellSeparatormachineneedsacertainamountofbloodflowinorderto

workproperly.Therefore,astrongveinwithgoodbloodflowisneeded.

If the veins are too small or delicate, the insertionof a temporary intravenous line called a “St Paul’s

Catheter”maybenecessary.ASt.Paul’sCatheterisasmallplastictubethatisplacedintoalargevein

locatedinthesideoftheneck.Sometimesitisnecessary(butrare)toplacetheSt.Paul’sCatheterinthe

largegroinvein,whichdrainsthebloodfromthelegs.Thistubeallowsthebloodtobeeasilyremovedand

returnedtoyourbody.IfyourequireaSt.Paul’sCatheter,thenursewillmakeanappointmentforyouwith

theAngio-RadiologyDepartment.TheSt.Paul’sCatheterwillbeinsertedthedaybeforeorthedayofthe

stemcellcollection.Thecatheterwillberemovedafterthecollectionsarecompleted.

ThenursesanddoctorsattheCSUwishtomakethecollectionexperienceasstress-freeandcomfortable

aspossible.Pleaseletthemknowifthereisanythingtheycandotoassistyouinthis.

6 77

G-CSFisavery

expensiveprescriptionmedicationandisnot

paidforbytheVancouverGeneralHospitalortheBC

CancerAgencyfortheautologoustransplantpatient.Unfortunately,thisistheonlymedicationthatcanbeusedtoincreasebloodstemcells.Generally,thecostofG-CSFforonecourseoftreatmentisbetween$3,000.00and

$3,800.00.

G-CSF Administration

Frequently Asked Questions - FAQs

What is G-CSF?

G-CSFisacolonystimulatingfactor.Colonystimulatingfactorsarenaturallyoccurringspecialproteinsin

thehumanbodythatstimulatebloodcellproductionandgrowth.G-CSFhelpsincreasethenumberof

stemcellsinyourbloodstream.

Thesenaturallyoccurringproteinscanalsobemanufacturedasadrug.TheG-CSFusedinourProgramis

Neupogen®.Thegenericnameisfilgrastim.

Why is G-CSF given?

Inordertolimitthenumberoftimesyouhavetoundergostemcellcollection,

theBMTdoctorwilltrytomoveyourstemcellsoutofyourbonemarrow

and into your blood stream. This process is calledmobilization.

TheG-CSF youwill receive will encourage the growth of stem

cells in your body andmobilize them into your blood stream

forcollection.

How will it help my transplant?

Engraftmentistheprocessbywhichre-infusedstemcells

grow in the bone marrow and manufacture new blood

cells.After your stemcells are re-infused, engraftment is

theindicationthatthenewstemcellsareworkingproperly.

Researchhasshownthatstemcellsthathavebeenmobilized

engraft faster than stem cells collected directly from the

bonemarrow.

How much does G-CSF (Neupogen®) cost?

G-CSFisaveryexpensiveprescriptionmedicationandisnotpaid

forbytheVancouverGeneralHospitalortheBCCancerAgency

for the autologous transplant patient.Unfortunately, this is the only

medicationthatcanbeusedtoincreasebloodstemcells.Generally,the

costofG-CSFforonecourseoftreatmentisbetween$3,000.00and$3,800.00.

SpecifictoAutologousTransplantPatients6 77

Otherdrugsmayinteractwith

G-CSF.Itisimportantthatyoutellyourdoctorifyouaretakinganyothermedications.Thisincludesover-the-counterdrugs,naturopath/herbalremedies,vitamins,

teas,etc.


Hereiswhatyouneedtoknow:

1.YoushouldberegisteredforBCFairPharmaCare.YoucancontactFairPharmaCare

(1-800-663-7100)toclarifyyourbenefitplanandmedicationcoverage.Ifyouhave

already reachedyourdeductible amountwithFairPharmaCare, in thepresent

calendaryear,thecostofyourG-CSFmaybegreatlyreduced.

2.DependingonyourextendedhealthplanandyourFairPharmaCaredeductible,

youwillneedtopayforsomeorthisentireamount“out-of-pocket”.

3.You may have drug cost reimbursement through an extended health plan or

fundingfromsocialassistance(MinistryofHumanResources).Youshouldcontact

the insurance carrier or your financial aid worker to discuss coverage of this

medication.

4.Ifyouhavetriedalltheaboveandstillcannotaffordthemedication,pleasecontact

theL/BMTCoordinatorortheL/BMTSocialWorkerassignedtoyou,todiscuss

thissituationfurther.

How is G-CSF given?

G-CSFwillbeadministereddailyby injectionthroughatinyneedleundertheskin.Arrangementswillbe

madeforyoutoreceiveyourinjectionseitherintheCellSeparatorUnit,theL/BMTDaycareUnitorifyou

preferyoumayarrangetohavethemgivenatyourfamilydoctor’sofficeorwalk-inclinicnearyourhome.

Generally,youwilltakeG-CSFfor5days.Stemcellcollectionwillcommenceonthe4thday.Onthe5thday

youwillhaveanearlyappointmenttocometotheCellSeparatorUnit(CSU)andhaveyourblooddrawn

inordertocheckyourbloodcounts.Assumingyourneutrophilcountissufficientlyhigh,

youwillproceedtohaveyourperipheralstemcellscollected.Ifyourcountsarenot

elevatedenough,youmaybeprescribedadditionaldaysofG-CSFtherapy.

What should I expect when injecting G-CSF?

When G-CSF is injected, you may feel a slight stinging sensation at the

injectionsite.Sometimes, injecting intoa largersurfaceareasuchas the

abdomenorinjectingthemedicationslowercanreducethestinging.Ifyou

experiencesomepainorrednessattheinjectionsite, itshouldgoaway

soon.Ifitdoesnot,contactyournurseordoctor.

Sometimesa“bump”occursattheinjectionsite.Do not rub it.Thebump

willoftengoawaywithinafewhours.Ifthebumppersistsformorethana

fewhours,contactyournurseordoctor.

8 99

Asmallamountofmedicationcansometimesleakoutattheinjectionsitewhentheneedleiswithdrawn.

Ifitdoes,simplyapplylightpressurewithanalcoholswab,butdonotrubthearea.

OtherdrugsmayinteractwithG-CSF.Itisimportantthatyoutellyourdoctorifyouaretakinganyother

medications.Thisincludesover-the-counterdrugs,naturopath/herbalremedies,vitamins,teas,etc.Inform

yourdoctorevenifyouonlytaketheseoccasionally.

What are the side effects of G-CSF?

Generally,G-CSF iswell tolerated.Somepatientshaveexperienceddiscomfortthat isusuallyreported

asheadacheand/oraching inthebones,mostoften inthebackandhips. Ifyoufeeldiscomfort,please

contactyourdoctorornurseforadviceonhowbesttorelieveit.Besuretotellyournurseordoctorif

youexperienceanysymptomsthatconcernyouwhileyouaretakingG-CSF.Nevertakeamedicationfor

asideeffect,orforanythingelse,unlessyournurseordoctorrecommendsit.

The Collection of Peripheral Blood Stem Cells

What to ExpectYourstemcellswillmostlikelybecollectedbyaprocedurecalledapheresis(a-fair-ee-sis).Twoendsof

tubingwillconnectyoutoacellseparatormachineduringthecollection.Yourbloodwillflowoutofone

arm,insidethetubing,tothemachinewhereitwillspinyourbloodaroundathighspeed.Thespinning

separatesthedifferentcomponentsofthebloodintolayersbasedontheirweight.Thestemcelllayerwill

thenbecollectedandtheremainingbloodwillbereturnedtoyouviatheotherarm.Thebloodalwaysstays

insidethetubingset.Thetubingandneedlesaresterile.Theyareusedonlyonceandthendiscarded.

Youwillbeattachedtothecellseparatormachinefor4–6hoursforeachcollection.Therewillbenurses

andtechnicianspresentfortheentiretime.Duringtheprocedureitisnecessaryforyoutostayinbed.

Eachbedareahasatelevisionsettohelpyoupassthetime.Youmayalsohaveafriendstaywithyou.

Side Effects During the Apheresis ProcedureTheapheresisprocedureissafe.However,therearesomesideeffectsyoumayexperienceandshould

beawareof:

• IfyouhaveanIV(intravenous)needleintheinsideelbowregionofyourarm(s)

youwillneedtokeepyourarm(s)straightduringtheprocedure.Sometimesthis

canbeuncomfortable.Pleaseletthenursesknowsothattheycanassistyouin

gettingascomfortableaspossible.


Youmaystarttofeellight-

headed,nauseated,coldorexperiencemusclecrampingortinglingaroundthelips,handsorfeet.Tellthenursesimmediately.


•Theflowofbloodfromyourveinscansometimesbeslow

andvariable.Inthiscase,thenursesmayaskyoutosqueeze

your hands to increase blood flow, change your arm

position,orthenursesmayadjustthelinesormachine.

Occasionallyaneedlewillhavetobereplacedinorderto

getbetterbloodflow.

• Changes in blood volume may make some people

feel dizzy or light-headed. You should tell the nurses

immediatelyifyoufeelanythinglikethis.

•Ananticoagulant(anti-clotting)drugismixedwithyour

bloodasitentersthemachinetokeepitfromclottingduring

the procedure. Thismay cause a sour taste in yourmouth.

Theanticoagulantcanalsoloweryourbloodcalciumandyoumay

experiencelight-headedness,nausea,musclecramping,and/oratingling

feelingaroundthelips,handsorfeet.Youshouldtellthenursesimmediatelyifyou

feelanyofthesesymptoms.Oralorintravenouscalciumwillbringquickreliefof

thesesideeffects.

•Youmaystarttofeelcoldduringtheprocedure.Ifyoufeelchilled,pleaseletthe

nurses know.They can give you extra blankets and heating pads to keep you

warmandcomfortable.

Frequency of Stem Cell CollectionsThegoal is tocollectenoughcells foroneortwotransplantsdependingonwhyyouarereceivingthe

transplant.Yourphysicianwill havediscussed thiswithyouprior toyour treatment.The targetedcell

collectionisusuallyachievedin1to2days.Occasionallyathirddayofcollectingisrequired.Thenumber

ofstemcellcollectionsneededlargelydependsonthepatient’sweightandresponsetotheG-CSFandthe

apheresisprocedure.

Immediatelyaftertheapheresisprocedureiscompleted,specimensareobtainedfromthebagofcollected

stemcells.Thesearesentassoonaspossibletoaspeciallabwherethesamplewillbestudiedandthe

actualstemcellcountwillbedetermined.Resultsofthisanalysiswillusuallybecompletedby4:00pmthat

sameday.Oncetheactualcountisknownandreviewedbythedoctor,youwillbenotifiedastowhether

morestemcellcollectionsareneededonsubsequentdays.

10 1111

When to Call the Doctor

•Haveafeverof38°C(100°F)orhigher

•Havechills

•Developarashorsymptomsofanallergicreaction

•Painwhenurinating

•Arebleeding, orhaveaproblemsuchasalump,

swellingorbruisingattheinjectionsitethat

doesn’t goaway

•Noticeanythingunusualaboutyourcondition

Processing the Stem Cell CollectionInordertopreservethestemcells,theywillneedtobefrozen.Thisprocessiscalledcryopreservation.

Shortlyafterthestemcellsarecollected,theyaresenttoaspeciallabcalledtheCryogenicsLab.There,

thestemcellswillbeconcentratedandapreservativewillbeaddedtoprotectthecellsfromthefreezing

process.Theywillthenbestoredinaspecialfreezingvaultuntilthetimeyou

needthem.

Storage of Stem CellsUnder the new policy, stem cells older than 7 yearswill be discarded or

donated to the Canadian Blood Services with the patient’s consent and

knowledge.Thequalityofthestemcellaftersuchalongperiodofstorageis

uncertain.YourBMTdoctorwilldiscussthisindetailwithyou.

When to Call the DoctorNeverhesitatetocallthedoctorornurseifyouhaveanysymptomsthatworryyou

orifyouareconcernedwithanyaspectofyourtreatment.However,contactthe

doctorornurseimmediatelyifyou:

•Haveafeverof38°C(100°F)orhigher

•Havechills

•Developarashorsymptomsofanallergicreaction

•Painwhenurinating

•Arebleeding,orhaveaproblemsuchasalump,swellingorbruisingatthe

injectionsitethatdoesn’tgoaway

•Noticeanythingunusualaboutyourcondition

Important RemindersThingstokeepinmind:

1.TheCellSeparatorUnit(CSU)canbereachedat604-875-4626.

2.AppointmenttimesforstemcellcollectionsattheCSUareusuallybetween

8:00amand9:00am.


Itisveryimportantthat

youhavebreakfastbeforecomingtothe

unit, preferablyonethatis richincalcium.

TheCSUcanbe reachedat

604-875-4626.


3.Theentireprocesscantakeupto4–6hoursfromstarttofinish.Thismakesfora

verylongday.Youmaywishtobringyourownlunchandsnacks. TheCSUcan

provide ju ice, cookies anda l imitedse lect ionofsandwiches.

4.ItisItveryimportantthatyouhavebreakfastbeforecomingtotheunit,preferablyone

thatisrichincalcium.

5.Donotdrinkcoffeeorteabeforetheprocedure,asyouwillnotbeabletoget

uptousethewashroomonceyouarehookeduptothecellseparator

machine.

6.Pleaseusethewashroomfacilities intheCSUjustbefore

theprocedurebegins. If youneed togo to thebathroom

duringtheprocedure,bedpansareavailable.Anursewill

help you with this. It is recommended that you wear

comfortableandloosefittingclothing(i.e.,pantswithan

elasticwaistbandmaymakethingseasier).

7.Youwillhaveyourowntelevisionavailableforyouruse

during theapheresisprocedure.Also,unlessyouhavea

St.Paul’sCatheter,readingmaterialswouldbeinappropriate

tobring,asyouwillnothavetheuseofyourarms.

8.Once the procedure has started, the nurseswill allowone

visitortostaywithyou.

9. It is very important to notify the nurses right away if you feel light-

headed,dizzy,nauseated,cold,orhavetinglingaroundthelips,fingersortoes,during

theprocedure.Slowingorstoppingtheprocedureforashorttimecansometimes

resolvesomeofthesesymptoms.

12

Autologous & AllogenicPhases of BMT:

Transplants


12

Autologousandallogeneic

bloodandmarrowtransplantsusuallyfollowthesefour

phases:

1.Pre-BMTPhase

2.BMTPhase

3.Post-BMTPhase

4.Discharge


Autologous and allogeneicbloodandmarrowtransplantsusuallyfollowthese

fourphases:

1.Pre-BMTPhase

2.BMTPhase

3.Post-BMTPhase

4.Discharge

Pre-BMT Phase

Diagnostic TestsManydiagnostictestsaredonepriortohavingabloodandmarrowtransplant.Somepatientswillhave

thesetestscompletedbeforetheyareadmittedtohospital.Otherswillhavethetestscompletedsoon

afteradmission.Thiswilldependupontheadmissiondateandtheschedulethathasbeensetupforeach

patient.TeststhathavetobecompletedonmostpatientspriortoaBMTare:

•Bloodtests,includingtestingforexposuretohepatitisandHIV(theAIDSvirus)

•Bonemarrowbiopsy

•Chestx-ray

•Dentalx-ray

•Electrocardiogram(ECG)

•Aheartfunctionstudy(RVG)

•Lungfunctiontests(PFTs)

Tolearnmoreaboutthesetests,refertoDiagnosticTests&ProceduresintheCoreModule.

Hickman® Line InsertionItisalsoduringthePre-BMTPhasethataspecialintravenouslineknownasaHickman®linemaybeinserted.

TheHickmanline®isanintravenousdevicethatisusedtogivefluids,bloodtransfusions,medications,and

thebloodstemcellsduringthere-infusionprocess.Somepatientsmayalreadyhaveacentralvenousline

whentheyareadmittedtothehospital.OtherswillhavetheirHickman®lineinsertedwithin1–2daysof

admission.

To learnmoreabouttheHickman® line insertionprocedure,refertoDiagnosticTests&Procedures in

theCoreModule.

14 1515

Conditioning Treatment

What is conditioning treatment?

Conditioningtreatmentisusedtoeliminatetheunderlyingdisease,createspaceforthenewmarrowand

preventrejectionofthenewbonemarrow.

Once theconditioning treatmenthasbegun,patientsusuallyneed tobe inprotective isolation tohelp

preventinfection.Protectiveisolationmeansthatitisnecessaryforthepatienttoremaininthehospital

roomorwardmostofthetime.However,therearecircumstanceswhenpatientsmustleavethehospital

roomorwardtohavetests inotherdepartments.Protective isolationcontinuesthroughouttransplant

andforaboutthreeweeksposttransplant,untilthepatient’sconditionandwhitebloodcellcounthave

improvedtoasatisfactorylevel.

Types of Conditioning Treatment

There is a variety of conditioning regimens that involve chemotherapy alone, or a combination of

chemotherapyandtotalbodyirradiation(TBI).YourBMTdoctorwillprovidedetailedinformationabout

theparticularconditioningtreatmentthatisrecommendedforyou.

1.Chemotherapy. All patients will receive chemotherapy drugs prior to the

bloodandmarrowtransplant.Thechemotherapyisgiveninhighdosesinorder

to eliminate the disease or cancer. In the case of an allogeneic (donor) BMT,

chemotherapy suppresses the immune system to allow the transplanted bone

marrowtoundergoaprocesscalledengraftment.Chemotherapyisadministered

byanurseinthepatient’shospitalroomthroughtheHickman®line.Yourphysician

willdiscussthepossiblesideeffectsofchemotherapyindetailwithyou.

To read more about chemotherapy agents and the possible side effects and

complicationsfromchemotherapyagents,refertotheChemotherapyModule.

2. Total Body Irradiation (TBI). Somepatientswill receive radiation therapy in

additiontochemotherapyduringtheirconditioningtreatment.Likechemotherapy,

totalbodyirradiation(TBI)isusedtoeliminatethediseaseandinthecaseofallogeneic

(donor)transplant,tosuppressthepatient’simmunesysteminpreparationforthe

transplantedstemcells.TBIisgivenintheRadiotherapyDepartmentattheBritish

ColumbiaCancerAgency.BeforereceivingTBI,patientsgototheRadiotherapy

Departmentforapre-treatmentappointment.Thepurposeofthisappointment

is to take specialmeasurements of height,weight, and body thickness so that

theradiationtreatmentscanbetailoredtoeachindividualpatient.Anumberof

specialmarkingsareplacedontheskinatthistimetoserveaslandmarkswhen

PhasesofBMT•Pre-BMTPhase14 1515

Notes


thetreatmentbegins.Thisplanningappointmentisanexcellenttimetomeetthe

staffintheRadiotherapyDepartmentandtoaskanyquestions.Wesuggestthat

youwriteyourquestionsdownandbringittoyourappointment.

Toreadmoreabouttotalbodyirradiationandpossiblesideeffectsandcomplications,

refertotheChemotherapyModule.

16 1717

Mostpeople

aresurprisedthattheactualinfusionofstemcellsisaverystraightforwardprocedure.

BMT Phase

The Transplant Process

What actually happens in the transplant?

Oncetheconditioningtreatmentiscompleted,youarereadytoreceivethedonor’s

oryourownbloodstemcells/bonemarrow.TheBMTPhaseistheshortestphase.

Theprocessconsistsoftheinfusionofthestemcells.Atthispoint,patientsareoften

relievedthattheconditioningtreatmentisover,andexcitedbythefactthatthetransplantcan

nowtakeplace.Thedayofyourtransplantwillbereferredtoas“Day0”.

Mostpeoplearesurprisedthattheactualinfusionofstemcellsisaverystraightforwardprocedure.The

stemcellsenterthepatient’sbloodstreamthroughtheHickman®line.Muchlikeabloodtransfusion,the

stemcellinfusionprocesstakesanywherebetween20minutestoacoupleofhours.

Anursewillbeintheroomfortheentiretransplantandadoctorwillbepresentforthebeginningandthen

availableontheunitfortheremainderofthetransplant.

Side EffectsPatientsdonotgenerallyexperienceanysignificantsideeffectsfromtheactualstemcell/bonemarrow

infusion.Somepeopledevelopchills,rashes,afastpulserate,orhighbloodpressure.However,eachof

thesesymptomsiscarefullymonitoredandtreatedasnecessary.

Anursewillbeintheroomfortheentiretransplantandadoctorwillbepresentforthebeginningandthen

availableontheunitfortheremainderofthetransplant.

Specific to Autologous Transplant

Ifyouareundergoinganautologoustransplant,i.e.,receivingyourownstemcells,yourstemcellswould

havetobefrozenandthenthawedpriortothetransplant.Toprotectthestemcellswhiletheyarefrozen,a

preservativecalledDMSO(DimethylSulfoxide)isused.Duringandafterthetransplant,youmayexperience

somesideeffectsfromDMSO.

TheDMSOmaycauseyoutohaveagarlic-like(oroyster/creamofcorn-like)tasteinyourmouththatwill

lastafewdays.Somepatientsfinditbeneficialtochewgumorsuckonhardcandiestolessenthiseffect

duringtheinfusion.Occasionally,DMSOcancausenausea,shortnessofbreath,wheezing,stomachpains,

loweredheartrate,orallergicreaction.Youwillbegivenmedicationbeforethetransplanttohelpprevent

PhasesofBMT•BMTPhase16 1717

Notes


themfromoccurring.AlthoughnotduetoDMSO,yoururinemaybecomered-colouredfor24hoursafter

theinfusion.Anursewillbeinyourroomduringtheentiretransplanttomonitoryouclosely.Adoctorwill

bepresentforthebeginningandthenavailableontheunitfortheremainderofthetransplant.

18 1919

Itisduringthe

Post-BMTPhasethateveryonelooksforwardtoevidencethatthetransplantedstemcellshavetravelledtotherightplaceandarestartingtowork.

Post-BMT Phase

Engraftment

What is engraftment?

ThePost-BMTPhaseisthelongestphaseofabloodandmarrow

transplant.Itbeginsfollowingthestemcell/bonemarrowinfusion,

andcontinuesthroughouttherecoveryperiod.

ItisduringthePost-BMTPhasethateveryonelooksforwardtoevidencethat

thetransplantedstemcellshavetravelledtotherightplaceandarestartingtowork.Engraftmentisthe

processinwhichthetransplantedstemcellsfindtheirwaytothebonemarrowspacesinthecentreofthe

largebonesofthebody.Onlythencanthetransplantedstemcellsbegintoproducenewbloodcells.

Expertsarenotcompletelycertainhowthisamazingprocesshappens.Ittakesapproximatelytwotofour

weeksafterthestemcell/bonemarrowisinfusedforengraftmenttooccur.

Thereareseveralwaysthatyourdoctorcantellthatengraftmenthasbegun.Thefirstsignofengraftment

isthegradualriseofwhitebloodcellcountorplateletcountthatbeginsabouttwoweeksafteryourBMT

day.Redbloodcellsoftentakealittlelongertobegindeveloping.

Graft-Versus-Host-Disease (GVHD)Graft-versus-hostdiseaseorGVHDisatermusedtodescribeabattlebetweenthetransplantedstemcells

andthepatient’sbody.Thisisacomplicationthatoccurswhenthenewstemcells(thegraft)rejectorsee

yourbody(thehost)asforeign.

WhileGVHDisextremelyrareinautologoustransplants,itoccursinapproximately50%ofpatientswho

haveanallogeneic(donor)transplant.GVHDislesslikelytooccurifthedonorandrecipientarematched–

haveidenticaltissueor“HLA”types.Theconditionisconsiderablymorecommonwhenthematchisonly

partialorifthedonorandrecipientareunrelated.Allpatientsreceivingbonemarrowfromadonor,unless

thedonorisanidenticaltwin,willreceivedrugstotrytopreventGVHD.

Of thosewhodevelopGVHD,manywill experienceonlyminordifficulties.Abouthalfwill experience

significantproblems.TherearetwotypesofGVHD:acuteandchronic.

Acute GVHD

AcuteGVHDmayoccurearlywhenthebonemarrowstartstoengraftaroundtwotofourweeksafterthe

transplant.AcuteGVHDmayinvolvethreemainbodysystems:

PhasesofBMT•Post-BMTPhase18 1919

GVHDisnotalwaysanegative

developmentfollowingabloodandbonemarrowtransplant.ThisisbecausetheimmunesystemthatattacksthehostcausingGVHDisalsoknowntoattackcancercells.ResearchershavefoundthatpatientswithGVHDgenerallyhave

alowerriskofhavingarelapseoftheircancer.


1.Skin GVHDusuallyshowsupasarashanywhereontheskinsurfacebut it is

mostlyseenonthehands,feet,abdomenandface.Theskin initially lookssun-

burnt.Therashmayprogresstootherareasofthebodyandpotentiallybecome

ablister-likerash.

2. Liver GVHDbecomesevidentinyourbloodwork.Bloodworkisdoneregularly

to test how your liver is functioning.With liverGVHD, these results become

elevated.LiverGVHDmayalsocausethepatienttobecomejaundiced(tohavea

yellowtonetotheskin).

3. Gastrointestinal Tract GVHD appears as nausea and vomiting and/or acute,

watery or sometimes explosive diarrhea. The amount of diarrhea can indicate

theseverityoftheGVHD.Anexamofthegastrointestinal tract isalsodoneto

confirmGVHD.

Chronic GVHD

ChronicGVHDoccursafter100dayspost-BMT.ItmaydevelopasacontinuationofacuteGVHDoroccur

without anypriorhistoryof acuteGVHD.ChronicGVHD isusually less serious. It ismost frequently

associatedwithsorenessordrynessofthemouthoreyes,lungandlivercomplications,changesinskin

pigmentation.Itmayalsocausehairloss,weightloss,vaginaldryness,cough,shortnessofbreathandjoint

problems.

Management

TomanageandtreatGVHD,anumberofdrugssuchascyclosporine,methotrexateandprednisoneare

usedearlyontohelppreventorminimizeGVHD.However,somesideeffectsofthedrugscaninterfere

withthepatients’qualityoflife.YourBMTdoctorwilldiscussthesewithyouindetail.

GVHD is not always a negative development following

a blood and bone marrow transplant. This is

becausetheimmunesystemthatattacks

thehostcausingGVHDisalsoknown

toattackcancercells.Researchers

have found that patients with

GVHD generally have a lower

risk of having a relapse of

theircancer.

20 2121

Infection –if any of these

symptoms appear, notify your nurse or

doctor immediately

• Fever of greater or equal to 38°C

(Celsius) or 100°F (Fahrenheit)

• Skin tenderness • Chills/sweating

• A burning feeling when urinating • Rectal pain/

tenderness • A cough, sore

throat or mouth pain

Managing Low White Cell Counts

Overview

Inahealthy individual,whitebloodcellsprovideprotection

against infections caused by bacteria, viruses and fungi.

There are several different types of white blood cells, but

neutrophils are the most common type. Neutrophils fight

infectionby rapidly increasing innumberwhenan infection

occurs.Theythensurroundanddestroythe infection.Your

“absoluteneutrophilcount”(ANC)ismonitoredcloselyafter

yourtreatmenttogiveusanindicationofyourabilitytofight

infectionandtoindicatethebeginningsofengraftment.

Afterreceivingyourtransplant,yourwhitebloodcellcount

willdecreasequicklyandwillremainlowuntilthenewcells

begin to grow (engraftment). During this time, you are at

greatriskfordevelopinganinfectionsinceyouwillnothave

whitebloodcellstofightbacteria,virusesorfungi.Although

theriskofinfectiondecreasesastheimmunesystemrecovers

(whitebloodcellcountrises),BMTpatientsmustcontinueto

takeprotectivemeasures until their bonemarrowhas fully

recovered.Recoveryonaveragetakes6–12monthsafterthe

transplant.

Precautions Against Infections

Many precautions are taken to prevent infection in bone

marrow transplant patients. For example, the protective

isolation procedures and guidelines for visitors are for the

purposeofpreventinginfectionwhileyouareinhospital.For

acompleteguidelineonhowtoprevent infections, refer to

YourResponsibilitiesintheCoreManual.

Signs of Infection & Management

Oneofthemostcommonsignsofinfectionisafever.MostBMT

patientswillhavean increase intemperaturethatmaysignalan

infectionatsomepointduringtheirtransplantexperience.Infections



canoccuratanytimepriorto,during,andafterthetransplant.Becauseallpeoplecarrygerms(organisms)

intheirsystemsnaturally,infectionsinthetransplantpatientareoftenfromthepatient’sownorganisms.

Althoughinfectionscanbequiteserious,therearemanyapproachestotreatment.Anti-bacterial,anti-viral

andsometimesanti-fungalmedicationsareprescribedduringthePost-BMTPhasetotreatthesedifferent

typesofinfection.

Tohelpidentifyanearlyinfection,itisimportanttoletthehealthcareteamknowhowyouarefeeling.

Somesymptomsofaninfectionare:

• Feverofgreaterorequalto38°C(Celsius)or100°F(Fahrenheit)

• Skintenderness

•Chills/sweating

•Aburningfeelingwhenurinating

• Rectalpain/tenderness

•Acough,sorethroatormouthpain

Ifanyofthesesymptomsappear,notifyyournurseordoctorimmediately.

Managing Low Red Cell Counts

Symptoms & Management

Redbloodcellscontainhemoglobinwhichcarriesoxygenfromthelungstoallofthetissuesinthebody.

Thisiswhatgivesusourenergy.Afteryoureceiveyourtransplant,yourredbloodcellcountwilldecrease

quicklyandwillremainlowuntilthenewcellsbegintogrow.

Whenredbloodcellsarelow,patientsbecomesanemicandmayfeelquitetiredandshortofbreathas

aresult.Othersymptomsmayincludedizzinessandfeelingchilled.Untilthetransplantedbonemarrow

startsmakingenoughredbloodcellsonitsown,youwillrequireredbloodcelltransfusionstomaintain

yourredbloodcellcount.Generally,whenyourhemoglobincountdropsbelow80,youwillreceivepacked

(concentrated)redbloodcells.Somepatientsmayrequirethemsooner.

Toreadmoreabouttransfusions,gotopage24.

Managing Low Platelet Counts

Overview

Platelets(thrombocytes)aretinybloodcellparticlesthathelpformclotsandpreventbleeding.Theydoso

bystickingtothesiteofabloodvesselinjury,clumptogether,andsealofftheinjuredbloodvesseltostop

bleeding.Whenplateletsarelow,youaremoresusceptibletobleeding.Somesignsandsymptomsthatmay

22 2323

Pleasenotifyyournurseordoctorofthefollowing:

1.Bruising

2.Bleedingwounds

3.Bloodinyoururineorstool

4.Bleedinggumsornose

5.Bloodinanymucous/sputum thatiscoughedup

6.Smallpinpointredorpurplespots underyourskin(petechiae)

occurwithlowplateletcountsincludebleedinggums,bruisingandnosebleeds.Urineandbowelmovements

willbecheckedforsignsofbleedingonaregularbasis.Becauseexcessivebleedingmayoccurduringmonthly

menstrualperiods,womenmayreceivespecialmedicationstopreventbloodlossinthisway.

Precautions Against Bleeding

Whileyourplateletsarelow,therearesomeprecautionsyoucantaketopreventbleeding:

1.Takegoodcareofyourskinandlips,asdrynessmayleadtocracksandbleeding.

2.Useonlyasofttoothbrush.Donotscrubyourgums

vigorously.

3.Avoidblowingorpickingyournose.

4.Useonlyanelectricrazor.

5.Wear shoes or slippers at all timeswhen

youareoutofbed.

6.Exercisebywalkingorridingastationary

bike. Avoid rough activity or exercises

thatmaycauseyoutoinjureyourhead

orotherpartsofyourbody.

Symptoms & Management

If your platelet count drops below “10” or you

havebleedingissues,youwillneedatransfusion.Your

plateletcountmaybecheckedasoftenaseverydayand

youwillbewatchedforsignsofbleeding. Pleasenotifyyour

nurseordoctorofthefollowing:

1.Bruising

2.Bleedingwounds

3.Bloodinyoururineorstool

4.Bleedinggumsornose

5.Bloodinanymucous/sputumthatiscoughedup

6.Smallpinpointredorpurplespotsunderyourskin(petechiae)

Until the transplanted stem cells start making enough platelets, you will require platelet transfusions.

Platelettransfusionsmayalsobenecessaryforaperiodoftimeafterdischargefromhospital.



Transfusions

Overview

Youmayrequireblood(redcells)and/orplatelettransfusionsfrequentlyduringyourtreatment.Withall

transfusionsthereisthepotentialofhavingatransfusionreaction.Becauseofthis,thebloodproductis

irradiatedandleuko-reduced(whitecellreduced)todecreasethelikelihoodofatransfusionreaction.If

youhavehadatransfusionreactioninthepast,pleaseinformyournurseordoctor.Ifatanytimeduringor

afteratransfusionyoufeelwarmorchilled,haveshortnessofbreath,aredizzy,noticehives(bumps/welts

onyourskinsimilartogiantmosquitobites)orifyourskinitches,notifyyournurseimmediately.

Where does donated blood come from? Is it safe?

Wholeblood is collectedbyCanadianBlood Services fromvolunteer donors.All potential donors are

screenedbyawrittenquestionnaireandinterviewedbyanurse.Thedonatedbloodisprocessedintoits

separatepartsandtestedfor:

1.HepatitisB

2.HepatitisC

3.HumanImmunodeficiencyVirus(HIV1and2–theAIDSviruses)

4.HumanT-CellLymphotripicVirus1and2

5.Syphilis

6.WestNileVirus(summertimes)

Ifthebloodisfoundtohaveanyoftheseinfections,itisdisposedofandneverused.Bloodisnevercollected

fromthisinfecteddonoragain.However,youneedtobeawarethatbloodcanneverbeguaranteedtobe

100%safe.Yourdoctorwilldiscussthisfurtherwithyoupriortoyourfirsttransfusion.Youwillneedto

signabloodproductconsentformbeforereceivinganybloodproducts.

Toreadmoreaboutthebloodtransfusionprocedure,refertoDiagnosticTests&ProceduresintheCoreModule.

Discharge

When are patients discharged?

Criteria for Discharge

Patientsreceivingatransplantcanusuallyexpecttobeinhospitalforatleastthreeweeks.Thehealthcare

teamensuresthatyouarestableenoughtopermitmonitoringasanoutpatientbeforedischargingyou.

24 2525

PlantostayintheVancouver

areaforseveralweeksafteryouaredischarged.Theremaybesomeexceptionstothisrule;however,youshouldbeawareofthisandmakethenecessaryarrangements

withoutdelay.

Afewcriteriathatneedtobemetpriortodischargeare:

•Bloodcellcounts(whitecells,redcellsandplatelets)havereachedasatisfactory

level.Youmaystillneedbloodproducttransfusionsasanoutpatient.

•Therearenocomplicationspresentthatwouldstopyoufrombeingmonitoredas

anoutpatient.

• Yourstatusisstableenoughtopermitmonitoringonanoutpatientbasis.

• You are able tomaintain adequate fluid intake and eat a satisfactory dietwith

sufficientcaloriestomaintainweight.

• Youhavesufficientstrengthandmobilitytoattendregularclinicvisits.

• YouoryourcaregiverisabletocareforyourHickman®line.

• Youareabletotaketherequiredmedications.

• Youhaveasuitableplacetolive,preferablywithin45minutesofthehospital,while

attendingtheOutpatientDaycareUnit.

Preparations for DischargePlantostayintheVancouverareaforseveralweeksafteryouaredischarged.Theremaybesomeexceptions

tothisrule;however,youshouldbeawareofthisandmakethenecessaryarrangementswithoutdelay.

ThisisnecessarysoyourprogressmaybemonitoredcloselyintheLeukemia/

BMTDaycareOutpatientUnit.

Beforeyouaredischarged,theclinicalpharmacistwillseeyou.

Theywillthoroughlydiscussyourdischargemedications

withyoubeforeyouleave.Theywillreviewwithyou

thepurposeofeachmedicationaswellasthedose,

time,special instructionsandmajorsideeffectsand

drug interactions. The pharmacist will provide you

with amedication calendar to help you keep track.

Keepitwithyouatalltimes.

IfyouaretakingcareofyourownHickman®lineathome,

thenursewillprovideyouwithasupplykitunlesstheHickman®

lineistoberemovedshortlyafteryourdischarge.

PhasesofBMT•Discharge24 2525


Discharge ChecklistBeforeyouaredischargedfromtheLeukemia/BMTInpatientUnit,pleasemakesurethattheitemsinthe

DischargeChecklisthavebeencompletedordiscussedwiththenurseordoctor.

Hickman® Line Care

IcanchangemyHickman®linedressingindependently.

Ineedmorehelplearningdressingchanges.

Icanflushthelineandchangethecapsindependently.

Ineedmorehelplearningflushingandcapchanges.

MyHickman®linekithasbeenpickedupfromtheBCCAPharmacy.

Icandrawbloodspecimens.

Ihaven’tlearnedtodrawbloodspecimensyet.

Icandointravenousinfusions:priming,starting,discontinuing.

Ihaven’tlearnedtodointravenousinfusionsyet.

Medications

Ihavereceivedmyprescriptions.

Iknowwheretohaveeachprescriptionfilled.

Iknowhowandwhentotakemymedications.

Ihaveanorganizingsystemformymedications.

Iknowwhatmymedicationsareforandthemajorsideeffectsanddruginteractions.

IknowwhotocallifIhaveanyquestions.

Monitoring for Complications

IhaveaCelsiusthermometertouseathomeafterdischarge.

Iknowwhatsignsandsymptomstoreportimmediately.

Iknowwhotocalltoreportsignsandsymptoms.

Iknowwhotocallforassistanceinanemergency.

Follow-Up at Leukemia/BMT Daycare Unit

IknowthedateandtimeofmyfirstCP6OutpatientDaycareUnitappointment.

IknowwheretheBMTDaycareUnitislocated.

IhavereadthesectiononOutpatientUnit:Leukemia/BMTDaycareintheCoreModule.

Ifapplicable,accommodationintheLowerMainlandhasbeenarrangedformydischarge.

26 2727

Notes

BMT Day 100 (3-Month) EvaluationMostBMTpatientswillhaveaseriesoftestsdoneapproximately3monthsaftertheirtransplant.Thegoal

ofthisevaluationistoreassesstheoutcomesofthetransplant.Theworkuphastwopurposes:

1.Todeterminethestatusoftheunderlyingdisease(theoriginaldiagnosis)

2.Toassessanypossiblesideeffectsofthetreatment

The testsarenecessary toruleoutanypossiblecomplications.These testscandetermine if there isa

problemeventhoughtheremaybenosymptoms.Youwillbefamiliarwithmanyofthetests.

There isoften aone-yearpost-BMTevaluation for the same reasons listed above.Again,manyof the

testswillbefamiliartoyou.YourBMTdoctororthenurseswillgiveyoumoreinformationaboutthese

evaluationsasthedayapproaches.

PhasesofBMT•Discharge26 2727

Notes


Disclaimer:

Pleasenotethattheinformationcontainedinthismanualisnotintendedtoreplacetheadviceofyourhealthcareteam.

Usethisasareferenceandeducationguide.Consultyourhealthcareteamifyouhaveanyquestionsorconcerns.


Mailing Address:

Leukemia/BMTProgramAdministration

10thFloor,2775LaurelStreet

Vancouver,BC

V5Z1M9

Telephone:

604-875-4863

Web Site:

www.leukemiabmtprogram.com

©2009Leukemia/BMTProgramofBC

FirstEdition:March2009

leukemia / bone marrow transplant (bmt) program of british ...€¦ · the new marrow and prevent...

Documents