Transplant Process

The process for getting a bone marrow transplant is a long one, from early planning all the way through long-term follow-up care.

When you come to BMT Aboad for a transplant: 

1. Your health care team will explain your transplant process and answer all your questions before your treatment begins.
2.  You’ll get a detailed manual called Preparing for Transplant and a manual for the type of transplant you’re receiving.
3. BMT Abroad offers classes each week to help patients and caregivers prepare for transplant and recovery.
4. Once you begin treatment, your transplant team will help you and your family navigate the entire process.
5. After your transplant, our long-term follow-up team will be here to provide you with lifelong care and support.

Here is an overview of the main steps: 

Initial consultation

Step 1: planning ahead

Step 2: preparation

Step 3: conditioning

Step 4: transplant

Step 5: waiting for engraftment

Step 6: recovering after engraftment

Step 7: long-term recovery

For many people, the process begins with an initial consultation at the BMT Abroad to discuss the possibility of a transplant.

1. You will meet with an expert transplant oncologist who specializes in the treatment of blood cancers with stem cell transplantation.
   
2. The oncologist will review your medical records, talk with you about your treatment options and make recommendations for you and your referring doctor.
   
3. A transplant nurse will answer your questions, give you an in-depth orientation to the transplant process and offer you a tour of there hospital and facilities.
   
4. You will have the option to meet with a representative from Patient Financial Services to talk about how much treatment costs, what your insurance covers and how to pay for your transplant.
   
5. We will give you a packet of transplant information to take home.
   
6. To schedule a consultation, call (+91) 8882921234. If you are from outside the area and you are not sure you can travel here for a consultation, please call us to talk about options.
   

Once your medical team recommends a transplant for you and you decide to proceed, you will begin the seven steps listed below. These steps are described in more detail in Preparing for Transplant.

Once your team recommends a transplant and you decide to proceed, you’ll want to organize your personal affairs and put plans in place so you can give your full attention to your recovery.

Selecting a caregiver: a responsible adult family member or friend to provide physical care, help monitor your health, administer medications, and give you emotional support. Your transplant team will teach your caregiver about these duties. Your caregiver must be available to be with you most of the time for many weeks.

Arranging to live in India for your transplant: if you don’t live here already. We require that you live within 30 minutes of the clinic for your safety. The length of time depends on your disease, treatment plan and response to treatment. A typical range is one month for an autologous transplant and four months for an allogeneic transplant.

Making financial arrangements to pay for your transplant and your living expenses.

Two main elements of preparing for a transplant are:

1. Preparing the donor, whether that’s someone else or you are your own donor.
   
2. Arriving at BMT Abroad for the meetings, evaluations and paperwork that need to happen right before your transplant.
   

Preparing the donor

1. If you are having an allogeneic transplant (using someone else’s cells), the preparation step includes finding a donor.
   
2. If you have one or more relatives who are available to donate, they will be tested to see if any is a close-enough match for you.
   
3. If you do not have a related donor, we will search internationally for an unrelated donor using donor registries.
   
4. If a match cannot be found, you may be able to receive a haploidentical transplant (using a half-matched family member) or a cord blood transplant (using an unrelated donor). These new sources of stem cells ensure that most patients needing a transplant will have a donor.
   

If you are having an autologous transplant (using your own cells), you are your own donor.

For a transplant using peripheral blood stem cells (PBSCs): Your preparation will include stem cell mobilization (receiving medicine that causes stem cells to leave the tissues they normally occupy and to circulate in the bloodstream). Either BMT Abroad or your referring doctor will start this process. After you arrive at BMT Aboad, we will collect your PBSCs.

For a transplant using bone marrow: We will harvest your bone marrow after you arrive in India for bone marrow transplant.

Arriving at BMT Abroad

Once your donor (or you, for an autologous transplant) has been prepared, you will come to BMT Abroad for more preparation.

Transplant workup: On the first day, you will meet with your primary provider and team nurse to discuss your health history, have a physical exam and blood draw, tour the clinic or hospital, get consent forms to review and receive your transplant manual.

Arrival conference: The next day, you will meet with your attending doctor and team nurse to discuss your treatment plan. You will be cared for by a team that specializes in the type of transplant you are having. Your team includes an expert transplant oncologist; a fellow, physician’s assistant or advanced registered nurse practitioner; and a registered nurse, pharmacist, dietitian, team coordinator and social worker. Your doctor will explain the transplant process, including benefits and risks, and answer your questions.

Evaluation for transplant: Over the next one to two weeks, you will have a thorough evaluation to confirm your diagnosis and evaluate your health. This will include tests and imaging

procedures, such as blood tests, bone marrow aspiration and biopsy, chest X-rays and an electrocardiogram.

Data-review conference: After your evaluation, your attending doctor will meet with you to discuss the results, answer your questions and get your official consent, if you want to move ahead with a transplant.

Education: You and your caregiver will attend classes and get individual instruction on topics like what to expect during the transplant process and how to care for your central venous catheter, manage symptoms and maintain proper nutrition.

Donor: If you have a related donor, this person will be with you, and we will evaluate your donor’s health. If you have an unrelated donor, that person will be evaluated at a different center closer to their home.

When you — and your donor, if you need one — are ready, your doctor will begin your conditioning regimen. You’ll receive chemotherapy, total body irradiation or both to weaken or destroy your cancer (or other disease-causing cells) and unhealthy bone marrow.

This will weaken your immune system, making you susceptible to infections, and may cause other side effects. Your team will teach you and your caregiver how to help prevent infections and manage side effects. They’ll also give you medicines to help.

Your transplant involves infusing cells into your body through a central venous catheter (a thin, flexible tube inserted into a large vein).

If you are having an allogeneic transplant, one of the following will happen right before your transplant:

1. Your donor will undergo stem cell mobilization in the days before your transplant, and their stem cells will be collected on the day of your transplant.
   
2. Your donor will undergo bone marrow harvesting on the day of your transplant.
   
3. Stem cells from cord blood will be defrosted, in preparation for infusion.
   

If you are having an autologous transplant:

1. We will have already collected your PBSCs or harvested your marrow before your conditioning.
   
2. These will be defrosted, in preparation for infusion.

Engraftment means the stem cells you received are growing and developing. In other words, your bone marrow and immune system are beginning to recover.

While waiting for engraftment :

1. We’ll closely monitor you and treat any side effects or complications.
   
2. Your transplant team and caregiver will provide supportive care as well as emotional support.
   
3. You’ll have blood tests to check for a rising white blood count — the first sign of engraftment, which usually appears in about 10 to 28 days.
   

For transplants with high-dose conditioning :

1. You will be hospitalized while waiting for engraftment.
   
2. The length of hospitalization varies, depending on the type of transplant, your response and many other factors.
   
3. Some people leave and then return to the hospital more than once, as needed.
   
4. For a reduced-intensity, or non-myeloablative, transplant, you may not need to stay in the hospital while waiting for engraftment.
   

You will continue to recover as an outpatient. The initial recovery period typically lasts:

About three months after an allogeneic transplant

About one month after an autologous transplant

During this period:

1. You will need to live within 30 minutes of the hospitals or clinic.
   
2. You will have clinic visits at least weekly as well as blood draws and other tests. We will gradually taper the frequency of your visits according to your needs.
   
3. Your caregiver will help you with your recovery.
   
4. A transplant registered nurse is available by phone 24 hours a day, 7 days a week to help you and your caregiver.
   

Toward the end of your initial recovery period:

1. If you had an allogeneic transplant, you may meet with staff from our Long-Term Follow-Up (LTFU) Program. They are dedicated to providing you with lifelong resources related to your transplant. They will work with your team to give you a comprehensive transplant discharge evaluation.
   
2. If you had an autologous transplant, you will not face the same long-term issues. If needed after you leave, you can plan visits through our LTFU telemedicine program.