The Blood and Marrow Transplantation Program

The Transplantation Process

In a blood or bone marrow transplant, immature blood cells are collected either from the patient or someone with matching blood chemistry and are infused into the patient's blood stream following intensive chemotherapy. Because chemotherapy usually kills the blood-producing bone marrow as well as the cancer cells, stem cells are transplanted to allow the bone marrow to regrow and start producing cancer-free blood cells again.

Outpatient Treatment

Our outpatient treatment program recognizes that a blood and marrow transplant is difficult for patients and requires a lengthy commitment to hospital-based treatment. Whenever possible during the actual transplant phase, we offer a treatment option that allows patients to stay either at home or in a nearby hotel rather than requiring patients to stay overnight in the hospital. A blood and marrow transplant requires an average of 21 consecutive days, but only 3 – 6 hours each day are spent in actual treatment. Rather than spending the rest of the time in the hospital, we encourage patients to stay at home if possible, or in one of several local hotels that make special arrangements for BMT patients. This provides increased privacy and quiet time and can make the treatment less unpleasant.

For more information about outpatient treatment, please read these articles in Dartmouth Medicine and in Focus.

What's Involved in a Transplant

Patients go through the following steps:

Referral – Patients are referred by their primary care physician, hematologist, or oncologist for a visit, called a consult, to talk with BMT specialists.  Click here for information about the referral process.

Consult Visit – The patient meets with the transplantation team. The physician, nurse practitioners, registered nurses and social workers  evaluate the patient’s  medical history to be sure BMT is the best treatment option.

Cytoreduction Chemotherapy – Before the patient is cleared to go ahead with BMT, an initial course of lower-dose chemotherapy is often given to reduce the amount of cancerous cells in the blood. 

Medical Clearance for BMT – After the initial chemotherapy, several days of laboratory and diagnostic tests are performed that allow the doctor to determine the patient’s detailed medical condition. The doctor decides when the patient is ready for the transplant process to begin.

Collection of Cells – In an autologous transplantation, blood stem cells are taken from the patient by apheresis (filtering out the hematopoietic cells) or by bone marrow aspiration. In an allogeneic transplantation, cells are collected from another person who matches the patient’s hematological profile. The blood stems cells are frozen and stored until time to reintroduce them to the body.

Transplant – When the doctor determines that the patient is ready for treatment, the process begins and continues through to completion – which can be three weeks or more. Two main steps are involved:

Intensive Chemotherapy – A major course of high-dose chemotherapy is given to eliminate all the cancerous cells. In addition to killing the cancerous cells, this also kills the bone marrow that generate new blood cells.

Transplant – The stem cells that were collected earlier are now given back so the body will begin making its own blood cells again. These cells make their way into the bone marrow, where they begin to make a new population of blood cells. This phase continues until the patient’s body begins generating its own blood cells again.

Outpatient Follow-up – Patients are discharged from the hospital after their blood counts are stable. Follow-up visits continue every 1-2 weeks for one or more months, depending on the yype of transplant. 100 days after the transplant, the patient is completely re-evaluated. Follow-up after that is based on each patient’s need, generally with brief checkups every 2-6 months.