Bone marrow transplant

julieK · Jul 9, 2004

I have a family member who needs a BMT and would like to know what the process is like. I've read what I could on the internet but would like a nurses perspective. I know all patients are different but how do people generally do?
Thanks in advance. She's 24 and doesn't have cancer but has aplastic anemia and needs the transplant for that purpose.

I am a new RN, and have just completed my first 6 months on an Oncology unit in NYC. We do lots of BMT's and it makes a big difference whether the patient is receiving his own stem cells or from a donor. With aplastic anemia, your relative will probably be receiving stem cells from a donor.

It is a long process and the patients often remain in the hospital for many weeks. Until the engraftment occurs, they are severely neutropenic and, therefore, at extreme risk of infection. They are often on multiple antibiotics, mostly for prophylactic reasons. They can get terrible mucositis and it can go from the mouth all the way through the digestive tract. They often need blood and platelet transfusions at least every few days.

Another main cause for concern is Graft vs. Host Disease. This is when the donated stem cells start attacking the patient as a foreign invader and is often deadly. I would be afraid to do it, but at the same time, this process is a life-saving one and many people end up doing well with it.

I wish you much luck and I hope this has helped give a different perspective.

-Julie

mac23 · Jul 9, 2004

Thanks Julie

That helps some. She hasn't made up her mind yet and although I'm a nurse all my experience is with babies. She is terrified and I tried to get her to talk to some people at the hospital who would know so hopefully after she gets through this stage in her thinking she'll be able to make a good, informed decision. I also just wanted to know so that I can prepare myself for what it might be like to help care for her. Thanks again

I am a new RN, and have just completed my first 6 months on an Oncology unit in NYC. We do lots of BMT's and it makes a big difference whether the patient is receiving his own stem cells or from a donor. With aplastic anemia, your relative will probably be receiving stem cells from a donor.
It is a long process and the patients often remain in the hospital for many weeks. Until the engraftment occurs, they are severely neutropenic and, therefore, at extreme risk of infection. They are often on multiple antibiotics, mostly for prophylactic reasons. They can get terrible mucositis and it can go from the mouth all the way through the digestive tract. They often need blood and platelet transfusions at least every few days.
Another main cause for concern is Graft vs. Host Disease. This is when the donated stem cells start attacking the patient as a foreign invader and is often deadly. I would be afraid to do it, but at the same time, this process is a life-saving one and many people end up doing well with it.
I wish you much luck and I hope this has helped give a different perspective.
-Julie

julieK · Jul 9, 2004

I'm glad I was able to help a bit. If you think of more specific questions, I might be better at answering those.

-Julie

Ladybug45RN · Jul 20, 2004

I have worked BMT for approx 10 years. Fortuneately people with Aplastic anemia often do well going through transplant. Often the horrible liver, renel, and cardic side effects occur because of so much prior chemo as in people recieving BMT for cancers. Because AA don't usually have years of prior chemo they have less risk of these SE although there is some risk.

The type of donor your friend receives might be the determing factors on how long she will stay immunosuppressed and/or how much graft vs host she might experience. If more than one doror is available, her doctor will be able to go over the pros and cons of v each with her...

mac23 · Jul 21, 2004

Thanks Ladybug. My sister decided to go ahead and do it so now it's trying to work out the finanical side of things. :eek: It's amazing how much it's all going to cost. She's still unsure of her decision but I want her to be sure that she's doing it for her and not because the rest of us want her to. Unfortunately I'm in another state so I can't help all I want to right now. I'm just trying to gather as much info as I can.

Do the patients usually experience pain? I feel so dumb. What are the signs of graft vs host disease? She only has one match which is our younger sister and it wasn't a perfect match. Anything else you can tell me about the process feel free to share. Thanks.

renerian, BSN, RN · Jul 21, 2004

I worked BMT for over 6 years and had many of them had a bill of an amount over 1,000,000 due to complications of the illness/BMT process and such. Some people maxed out their lifetime insurance benefit and went bankrupt. Many did fine though due to limited complications. We had several in the hospital 6 months. Most were in for about 8 to 15 weeks.

renerian

Ladybug45RN · Jul 21, 2004

if your sister has pain it may come in the form of mouth sores which makes it hard to eat or swallow (mucositis). usually narcotics can be given if the pain is too bad.

the amount of graft vs host she may experience is parially dependent on how close a match your other sister is. there are several types of gvh, including gvh of the skin and gut. with skin gvh a rash appears about the same time her white blood count starts to rise....that might be the first sign. with gut gvh she may start having lots and lots of diarrhea or belly pain. your sister will probably be on anti rejection meds and/or steroids. if she develops gvh they most likely will first increase these meds to see how she does.

i have seen some folks with perfect sib matches that have lots of gvh and some mismatch sibs that hardly have any at all. it seems pretty unpredictable.

again peple with aa usually tend to do pretty well for several reasons 1)no prior chemo which weakens system and organs 2) usuall don't have to give such high doses of chemo (since there is not much in the bone marrow anyway it is easier to kill of what remains vs a leukemia for instanse) 3) could have less risk of gvh due to your isters own bone marrow failing to produce cells due to the aplastic anemia.

there are certainly other side effects that could occur as well such as failure to engraft. her doctor should discuss all these things with her.

expect fevers. they happen to 99% of people getting transplants. she will be watched for infections.

i've been trying to think about the aa we have transplanted and i think all have them have done very well to fairly well. of course her age is in her favor as well.....

good luck to your sister and family!