What does transplant day look like for the patient? What will the patient experience?

What does the transplant process look like for a patient?

When patients are getting ready to go to hospital, they should expect that they will stay in the hospital for about four weeks. Might be a little longer or might be a little shorter in some cases. But on average, that's how much it takes for hospitalization for allogeneic BMT.

The first week or couple of days, they are receiving chemotherapy, in some cases, also radiation, total body radiation. One or two days after that, they are ready to receive the stem cells of the donor.

So after the transplant procedure from chemotherapy or radiation, patients can experience some complications, these general complications early on include nausea, vomiting, diarrhea, mouth sores or in some cases that can be severe enough that patients will dive in nutrition or IV, pain control related to these mouth sores.

They have low blood counts and they will need transfusions of red blood cell transfusion and platelet transfusions. And their neutrophils, which are the infectious fighting cells, can be very low and they are at risk of infectious complications, will receive antibiotics to prevent infections while they are in the hospital.

And to prevent graft versus host disease, they are receiving immunosuppressive therapy early on after the transplant. And we continue it up to six months in some patients and maybe longer if they have chronic graft versus host disease.

But the first two to three weeks is the most vulnerable time period from a complication risk standpoint due to chemotherapy and radiation. After that, when neutrophils recover to a safer range and they don't have any active medical problems, we discharge patients from the hospital.

We continue to follow them very closely in outpatient BMT clinic, so they should be under the care of a BMT provider up to 100 days from the transplant, since they still will be at risk of developing graft versus host disease or infectious complications or even organ toxicities.

This is how I can best summarize the initial course of the transplant, and then after 100 days, they no longer require caregiver support in most of the cases, and they can go back home if they came from far. And we see them infrequently while still assessing for chronic graft versus host disease or tapering immunosuppression to get them off immunosuppression by six months if they don't have any active chronic graft versus host disease for us to treat.

I also want to mention that close to 15 to 20% of the patients will have ongoing chronic graft versus host disease that will not be able to take them off immunosuppression. So they require definitely ongoing care with bone marrow transplant providers, but that's still okay as long as they don't have a recurrence of their disease.

Instead of dealing with malignancy, we end up dealing with a condition which is chronic graft versus host disease. And it's definitely a more benign condition. And people can live with that.

I mean, if patients are already after transplant and they are in the hospital that first couple of weeks, they will have complications related to the transplant procedure, such as I mentioned, they having nausea, vomiting, diarrhea, and potential infectious complications. This is the timeline that they are most vulnerable. That's why we keep patients in the hospital for close observation and treatment of all of these complications.

However, their quality of life gradually improves, particularly when their neutrophils recover and we discharge them from the hospital. Most of the patients still will have fatigue for several weeks, in some cases even longer after transplant. But they gradually recover, particularly if they don't have any active infection or graft versus host disease, then they eventually get back to their normal state and are capable of doing their daily activities.

We, however, require social isolation early on after transplant, in some cases up to six months when they are still on immunosuppression to protect them from getting infectious complications. But then patients can start going back to work, and depending on what type of job they do, most of the patients will go back to work close to six months after their allogeneic transplant.