The decision to undergo a bone marrow or cord blood transplant (also called a BMT) can be stressful for you and your family. The treatment is hard on your body and can be hard emotionally, too. A transplant doctor will examine you to be sure that a transplant is a good treatment option for you and to better plan your treatment during the transplant process.

Learning about your health

The chemotherapy and radiation that you receive immediately prior to your transplant have the potential to seroiusly damage the heart, lungs, liver and kidneys. Tests are done before transplant to determine your risk for damage to these organs. It is important that you understand these risks before deciding to have a transplant.

Physical exam and tests

Pre-transplant exams vary from hospital to hospital. Listed below are tests that your doctor might order before transplant. Not all tests are performed on all patients. You may also have additional tests, depending on your diagnosis and health history.

• Echocardiogram (ECHO)/MUGA/Electrocardiogram (ECG): Tests to determine the heart's ability to circulate blood through the body.
• Dental exam: The mouth and teeth are a potential source of infection during transplant. You must be examined by a dentist and have any necessary dental work completed.
• Blood tests: Blood tests are done to evaluate the liver and kidneys and check for any infectious diseases.
• Pulmonary function tests (PFTs): PFTs determine how efficiently air is moved in and out of your lungs and how well the lungs are delivering oxygen to the bloodstream.
• Bone marrow aspiration and biopsy: If you are being treated for a blood-related cancer, a bone marrow biopsy and/or bone marrow aspiration will be done to confirm your disease is in remission.
• Positron emission tomograph (PET) scan: PET is a highly specialized X-ray that uses short-acting radioactive substances to produce powerful images of the body's internal organs. PET distinguishes cancer cells from healthy cells.
• Lumbar puncture or spinal tap: During a lumbar puncture, fluid from the spinal canal is removed and sent for tests to look for signs of cancer. If any diseased cells are found in this fluid, the disease will need to be treated before your transplant.

Health history review

Your doctor will also review your health history by asking you questions about your health. With a good understanding of your health history, your doctor can better decide whether a transplant is a good option for you. Your doctor will also be better prepared to treat or prevent problems.

Infection history

Your doctor needs to know about any infections you have had. Infections can be life-threatening after a transplant, when your immune system will be weak.

One infection that can be especially dangerous is called aspergillus. Aspergillus is a common fungus found in the soil and in the air. If you have had aspergillus or a similar infection, your doctor will want to make sure that infection is completely gone.

Some infections can also return easily after transplant. If your doctor knows you have had these infections, you can be treated to try to prevent their return.

Previous treatments

Many patients planning to undergo a bone marrow or cord blood transplant have been treated with chemotherapy or radiation therapy. These treatments can damage organs such as liver or kidneys. The treatment you receive to prepare for transplant (preparative regimen) may add to this organ damage. Your transplant doctor will need to know the kind and amount of any treatment you received. He or she may adjust your preparative regimen based on the treatment you had earlier.

Mental health concerns

Your doctor needs to know if you will be able to handle the stress and demands of your transplant. If you have a mental health issue, your doctor will see whether your mental health or any medications you need could interfere with your transplant treatment. If you have signs of alcohol or drug abuse, you may not be healthy enough for a transplant. You may also need to be evaluated by a mental health professional before deciding to go forward with a transplant.

Your doctor also wants to be sure you have someone to give you emotional support and help take care of you during and after your transplant. Many transplant centers require you to have a caregiver. Your caregiver will help you in the hospital and take care of you when you go home.

After your bone marrow or cord blood transplant (also called a BMT), you will have low blood counts. This means that you have fewer than normal numbers of red blood cells, white blood cells and platelets. Over time, the donated cells you received for your transplant start to grow and make new blood cells. This is called engraftment.

Engraftment is an important milestone in your transplant recovery. For information about how doctors check your blood for signs of engraftment.

Preparative regimen side effects

In the first 30 days after your transplant, you may also have some side effects from the preparative regimen you received before your transplant. Some of these side effects can be serious, and others are less serious, but can be painful or uncomfortable. For information about possible side effects you may have during this time and how your transplant team will treat them. 

Transfusions and growth factors

Until your donated cells engraft, you may get red blood cell or platelet transfusions. On average, transplant recipients get one red blood cell transfusion a week, and two to three platelet transfusions a week.

You may also get growth factors — drugs that help the body make more blood cells. Growth factors may help donated cells engraft more quickly. A common growth factor is granulocyte-colony stimulating factor or G-CSF (also called filgrastim or Neupogen^®). G-CSF helps the body make white blood cells.

Preventing common complications

Infections

Until your donated cells engraft, you will have low counts of all types of blood cells. You will have very few white blood cells to fight infections. This means you can get an infection easily and infections during this time can be serious, even life-threatening. Your transplant team will take steps to protect you from infections. You will be at risk for infection for many months, but the period before engraftment is a time of especially high risk.

Infections can be caused by bacteria, by viruses or by fungi. You will probably be given drugs to prevent infection even if you do not have any signs of infection. (Drugs given to prevent infection are called infection prophylaxis.) If you get a high fever or other sign of infection, your doctors will give you drugs to treat the infection.

• Bacterial infections — Bacterial infections are so common that most patients will have at least one during this time. They are most often caused by the bacteria normally in your mouth and gut. Infections around the place where the central line enters your body are also common.
• Viral infections — The most common viral infection is herpes. If you have had herpes before, the herpes virus remains in your body and can become active when your white blood cell count is low. Another common viral infection is cytomegalovirus (CMV). Many people have this virus in their bodies without symptoms, but when your white blood cell count is low, CMV can develop into an active infection.
• Fungal and yeast infections — The most common fungal or yeast infection is candida. The candida yeast lives in the mouth, intestines and vagina. Normally, bacteria in the body control candida, but the drugs that protect you from bacterial infections destroy these helpful bacteria. Candida can then grow into an active infection. Candida infections usually are fairly easy to treat. However, another common infection called aspergillus can be harder to treat. Aspergillus infections occur most often in the sinuses or lungs.

You can take some steps to avoid infections. You can take daily showers or baths to wash bacteria from your skin. Careful cleaning of your teeth and gums with a soft toothbrush or sponge is also important. You can also eat a low bacteria diet — avoid eating foods that are likely to carry bacteria. Foods you may need to avoid include raw foods, such as raw fruits and vegetables. Your transplant center will help you choose safe foods to eat. For more information about eating safely to avoid infection.

After you receive a bone marrow or cord blood transplant (also called a BMT), your doctors will watch your health carefully. Especially during the first 100 days after your transplant, you are at risk for complications. You and your transplant team can take steps to prevent some of these problems. Your doctor will work quickly to treat complications that do occur.

Getting healthier and leaving the hospital

After your donated cells engraft (begin to grow and create new blood cells for your body), your blood cell counts will begin to go up and your immune system will become stronger, although it will be weaker than normal for many months. Your transplant team will still care for you and watch you closely for complications. Sometime during the first 100 days, you will probably be able to leave the hospital and receive your care as an outpatient.

Transplant centers have different plans for patient care and the stage of recovery at which transplant patients transfer from the hospital to outpatient care varies. In your first weeks or months after you leave the hospital, you will go to the outpatient clinic often, perhaps even daily, for care. If you travel to a transplant center far from home, you should plan to stay near your transplant center for treatment for at least the first 100 days and until any transplant complications are resolved.

When you do leave the hospital, you and your family will need to plan for your caregiving needs and prepare the place where you will stay (whether it is your home or an apartment near your transplant center). For more information click on the links below.:

• Preparing Your Home for Your Recovery
• Healthy Eating
• Caring for Your Loved One after Transplant

There are some things you can do to rebuild your health and strength. It is important to get enough rest. You will probably be tired because your body will be working hard to recover from the intense treatment you received during your transplant. Try to be patient with yourself and with the time it may take for your body to heal.

It is also important to get some exercise every day, as you are able. Many people who have had a transplant say it helped them to get up and walk each day, even if they could only walk a short distance. Over time your strength will grow and you will be able to do more. For more information about ways you can help your body recover. 

Infections

After your transplant your immune system will be very weak. This is caused by the preparative regimen you receive before your transplant. It is also caused by some drugs you will take after your transplant, such as those used to prevent a complication called graft-versus-host disease (GVHD). Because your immune system is weak, your body may not be able to fight common viruses, bacteria and fungi that can cause infections.

Most infections happen in the first 100 days after transplant, but they remain a risk as long as your immune system is weak. Infections can be very serious, so your transplant team will watch you closely for signs of infections. Especially after you leave the hospital, you and your caregiver will also need to watch for signs of infection. If you do see signs of infection, tell your transplant team right away. It is important to treat infections quickly. Some common sites of infections are:

• The place where the central line (catheter) enters your body
• Mouth
• Urinary tract
• On or near the rectum
• In the blood
• Lungs

While you are in the hospital, your transplant team will check your body temperature at least 4 times a day, because fever is a strong sign of an infection. You may be given blood tests to check for signs of infections. You may also take infection-fighting drugs (antibiotics) even if you have no signs of infection. Drugs used to prevent infections are called infection prophylaxis.

Pneumonia is a serious infection risk in the first 100 days after transplant, so your doctors will watch for problems with your lungs. Pneumonia can be caused by bacteria or viruses. Pneumonia is a serious complication and can be life-threatening, but doctors have many drugs to treat it.

Even one to two years after your transplant, your immune system may not be at full strength. You may still need to take anti-infection drugs. Patients who get GVHD may have weak immune systems for even longer. 

Acute graft-versus-host disease

Graft-versus-host disease (GVHD) is a common complication after an allogeneic transplant (which uses cells from a family member, unrelated donor or cord blood unit). In GVHD, the immune cells from the donated marrow or cord blood (the graft) attack the body of the transplant patient (the host).

GVHD that appears in the first 100 days after transplant is called acute GVHD. When GVHD occurs later, it is called chronic GVHD. To learn more about GVHD, including how doctors prevent and treat it, see Graft-Versus-Host Disease under the Treating Complications Tab in the "You and Survivorship" section on marrow.org. 

Graft failure or rejection

Doctors call the cells you get during your transplant a graft. Graft failure is when your body does not accept the donated cells. The donated cells do not make the new white blood cells, red blood cells and platelets you need. Generally, doctors define graft failure as no signs of engraftment by the 42nd day after transplant.

Graft failure is a serious complication, but the rate of graft failure is usually low (about 5%). However, a number of patient and disease-related factors can affect this risk. The most common treatment for graft failure is another transplant. The second transplant may use cells from the same donor or from a different donor. Patients who have graft failure after a cord blood transplant cannot get backup cells from the same cord blood unit. However, doctors may be able to use a different cord blood unit or a backup adult donor instead.