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The Transplant Process evaluation | informed consent | conditioning regimen | transplant day |
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Pre-Transplant Evaluation
Prior to transplant, each patient will undergo a series of tests to evaluate their general health and determine if they can withstand the exacting process of transplant. The evaluation will likely include a chest x-ray, pulmonary function test, MUGA scan and ECG (heart evaluation), liver function tests, kidney function tests, blood tests to evaluate infectious diseases, bone marrow aspiration and biopsy and a spinal tap if needed. Some patients may require a full
radiological evaluation including CT scans, bone scans, and/or
MRI. If necessary, consults may take place with other medical specialties (e.g. pulmonary, cardiology) prior to admission for transplant. For patients receiving radiation as part of their conditioning regimen, a meeting with the radiation/oncologist will take place. The radiation oncologist will describe the treatment process and side effects of radiation therapy. In addition, the radiation oncologist will perform a simulation to delineate the areas of the body to be radiated. Patients who receive Total Body Irradiation
(TBI) will be evaluated for "shielding" of areas protected during radiation i.e. lungs, reproductive organs. Part of the pre-transplant preparation will also include the placement of a vascular access device or
catheter by a surgeon or interventional radiologist into a blood vessel that enters the heart. This catheter is inserted under the skin and will enable the patient to receive medications and blood products intravenously. Informed Consent
TrPrior to transplant, a meeting with the patient and their family to review the consent form and discuss any questions related to the plan of treatment and side effects will take place. The consent form is a written summary of the
treatment plan and the patient's signature is documentation of agreement to participate in
the treatment plan. According to the Food and Drug Administration (FDA) informed consent is more than just a signature on a form, it is a process of information exchange. The FDA further states that the entire informed consent process involves providing a patient with adequate information concerning the study, providing ample opportunity for the patient to consider all options, responding to the patients questions, ensuring that the patient has understood the information, obtaining voluntary permission to participate and, continuing to provide information to the patient as the situation requires. The informed consent process is most effective when there is an open exchange of information and questions between the patient and the expert.
Conditioning Regimen
Upon completion of the pre-transplant evaluation and the stem cell harvest, the patient will be ready for admission to the hospital. Once admitted the patient will begin conditioning. Conditioning or the preparative regimen is the chemotherapy and/or radiation the patient receives prior to transplant. Traditionally, the standard preparative regimen is aimed at destroying the bone marrow entirely to make room for the transplanted marrow. Newer conditioning modalities employing less toxic methods are being studied. This is known as "transplant light" or
"low-tox" conditioning. Typically conditioning lasts between three and eight days and may vary according to disease type, protocol, and institution where the transplant is being performed. Transplant Day
Transplant day is usually one or two days after the completion of the conditioning regimen and is often referred to as day zero. Usually patients do not receive cytotoxic therapy on the day of transplant. The stem cells will be infused intravenously, via the central venous catheter, and the procedure takes place in the patients room. The length of the infusion depends on the type of transplant and the volume of cells to be infused. The average infusion lasts anywhere from thirty minutes up to four hours. Patients are monitored before, during, and after the infusion for any signs or symptoms of a reaction similar to reactions seen with blood transfusions. After the cells are infused, it takes approximately two to four weeks for engraftment to occur.
This page was last edited on 06/26/2008 Written by Katie
Mullaly, RN, MSN cancerpage.com |
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