This section will explain the typical steps and procedures for both Autologous and Allogeneic transplants at the Emory Bone Marrow Center.  A list of cancers now treated with high dose chemotherapy and/or irradiation and autologous or allogeneic donor marrow or stem cell transplant can be found below.

Phases of Transplant

• Pre-transplant Evaluation;
  During this phase, the patient's physical, mental and emotional status will be assessed. The transplant team, including the physician, medical staff and social worker, will design a plan that encompasses all phases of the transplant process including;
  • treatment options
  • housing options
  • caregiver availability
  • financial resources
  • coping strategies

This is the time for the patient to share his or her feelings and concerns with the transplant team and receive answers to the many questions he or she may have.

Pre-Transplant Tests

• A series of tests will be conducted to further evaluate the patient's vital  functions and condition including:
  • Lab tests: blood and urine samples to determine organ function and status.
  • Pulmonary: breathing tests to measure lung function.
  • Cardiac: Echocardiagram and EKG
  • Radiology: Chest X-ray to check lung condition and potentially CAT Scans and Bone Scans to monitor the status of the patient's disease.
  • Bone Marrow Biopsy and Aspirate: a sample of bone marrow is taken to check for malignancy and determine a cell count
  • Lumbar Puncture: a sample of spinal fluid is taken to check for malignant disease.
    *The last two procedures will be given with medications to help alleviate possible pain and discomfort.

Identifying and Training Care Givers

• A caregiver is essential for all transplant patients. Usually the caregiver is a member of the family but also can be a close friend or neighbor who wants to help out. Most importantly, the caregiver should be someone who cares deeply about the patient and who can provide emotional support as well as intensive medical care. The caregiver should also be:
  • Able to provide 24 hour care or share a portion of that time with another trained caregiver.
  • 18 years of age with the ability to provide transportation to the clinic/hospital at any time.
  • English speaking with the ability to read and understand all directions for the patient's care.

Click here on Caregiver  to learn more about the responsibilities expected of this important role or look under the SUPPORT bar on the menu.

Stem Cell Collection

• Stem cells are collected from either the patient in an Autologous (self) transplant or via a donor with an Allogeneic transplant.
• The procedure is conducted with either a bone marrow harvest or peripheral stem cell collection.
• Bone Marrow Harvest Procedure: The procedure for autologous collection or allogeneic related donor is conducted at Emory in the Outpatient Ambulatory Surgery. Unrelated donor marrow harvests are usually done at other centers and the bone marrow graft is flown into Atlanta. 
  • Donors will be given a battery of tests prior to the procedure to ensure they are fit to undergo the harvest.
  • Autologous marrow is collected when the patient is determined to be as disease free as possible and frozen for re-infusion following chemo conditioning. 
  • After the donor/patient is medicated, needles are inserted into the cavities of both rear hipbones, which contain large quantities of marrow. The marrow, a thick red liquid, is extracted through a syringe. Surgical stitches or incisions are not necessary although several punctures may be needed to extract enough fluid.  This will vary depending on the donor/patient. This procedure lasts about one to two hours and is given under general anesthesia. 
  • About 1 1/2 quarts of marrow are usually harvested; only about 20 % of the body's total bone marrow. The harvested marrow is filtered and processed for infusion following a patient's chemo/radiation conditioning.
  • Peripheral Blood Stem Collection: The process for collecting stem cells from circulating (peripheral) blood is called apheresis. At Emory this is done in the Hemapheresis Department located in Emory Hospital.
  • The stem cells are harvested by separating blood using a centrifuge.  Blood is taken from the patient from one vein and passed through the centrifuge, where a fraction containing the stem cells will be removed.  The remaining blood is returned to the patient through another vein.
  • The procedure may be repeated in additional sessions of about four hours each until an adequate supply of stem cells are collected.  The number of collection days will vary based on the patient's illness and the number of cells collected in each session.

• Chemo/Radiation Conditioning
  • High dose chemotherapy or radiation is used to destroy the diseased cells and suppress the immune system to prevent rejection of a donor graft. The type of chemotherapy and/or radiation a patient receives depends upon the disease and can take two to seven days to complete. The chemotherapy is given through either an intravenous catheter line or orally.
  • Side effects aren't generally experienced until after the conditioning.
  • These range from mild to severe, including nausea, vomiting, diarrhea, hair loss, fatigue, irritability, loss of appetite/taste, mouth sores, fever and susceptibility to infection.
  • Patients at Emory are given medications to manage the side effects and monitored continually to assess progress.
  • The conditioning days are called "minus days" on a countdown to the stem cell/marrow infusion day, which is referred to as "DAY ZERO". 

• Infusion
  • Infusion of the collected marrow or peripheral blood stem cells is called "DAY ZERO," one to two days after completed conditioning. The infusion is usually no more complicated than a blood transfusion.
  • The procedure requires no special preparation, but drugs are administered if necessary for nausea and to prevent an allergic reaction. The infusion will take from one to three hours depending on the amount collected and is infused through the patient's tunneled catheter. Reactions are very uncommon.
  • When the infusion is completed, the patient begins the "waiting for engraftment,"  (growth) period.

• Waiting for Engraftment
  • In this phase, also called the"pancyctopenic" period, the infused stem cells circulate through the blood stream and relocate in the bone marrow cavities. The bone marrow cannot produce its own blood cells until stem cells engraft in the cavities, raising the risk for anemia, bleeding or infection. The waiting period generally takes two to four weeks.
  • The Emory Bone Marrow Team closely monitors patients during this time, administering daily oral antibiotics to prevent infections and giving blood and platelet transfusions as needed. Side effects can range from mild to severe, which each individual experiences differently.
  • Patients and caregivers must be aware of the risks of high dose chemotherapy/radiation and closely follow care instructions to prevent transplant complications.
  • Emory's BMT manual provides patients with detailed "waiting for engraftment " guidelines for preventing infections, symptoms to look for and products and practices to avoid. 

• Recovery
  • An increase in blood counts and the patient's strength and energy are key indicators of bone marrow growth. Recovery may vary depending on the type of transplant and the patient's general health
  • The Emory team will continue to monitor the patient closely in the clinic for at least one to three months following the transplant.  Further tests, such as bone marrow biopsy, will be given and provided to the referring physician along with a complete record of the patient's transplant process.
  • And before a patient is released back to the care of the referring physician, the team will review key steps needed to maintain good health following the transplant.

Cancers now treated by high dose chemotherapy and/or irradiation and autologous or allogeneic donor marrow or stem cell transplant include:

• non-Hodgkin's lymphoma,
• Hodgkin's disease
• multiple myeloma
• myelodysplastic syndrome
• chronic and acute leukemias
• aplastic anemia