Choosing to have a blood and marrow or cord blood transplant (also called a BMT) can be a tough decision. The thought of undergoing a complex medical procedure may be upsetting, or feel overwhelming. But "there are a lot of misconceptions out there," says Meg Blaney, RN. And this misinformation can feed a good deal of patient anxiety about BMTs.

The truth may be less distressing than you think: "I had a patient recently who was relieved to learn that a blood and marrow transplant is not a surgical procedure," said Blaney, a member of the oncology transplant team at the University of Rochester Medical Center in NY. "It's a transfusion."

What Is a Bone Marrow Transplant?

Bone marrow is the soft, fatty tissue inside your bones. A BMT replaces damaged or destroyed bone marrow stem cells with healthy bone marrow stem cells. Stem cells are like seeds: they are immature organisms that give rise to all of your body's blood cells.

More than 14,700 bone marrow or umbilical cord blood transplants were performed in the US in 2009, according to the Center for International Blood and Transplant Research. BMTs can be performed with your own cells (called autologous), a relative or donor's cells (called allogeneic), or from previously stored umbilical cord blood. Depending on the circumstances—the treatment being used and where it is being performed, for example—all or part of a transplant may be conducted on an outpatient basis.

BMTs for Cancer Patients

Many of those who need bone marrow transplants are cancer patients. But before a transplant, treatments such as chemotherapy, radiation, or both may be administered to control or stabilize the disease. Later, stem cells are delivered through a tube called a central venous catheter, and travel through the blood to the bone marrow.

"For many cancer patients, having the procedure generally isn't worse than what they've already endured," explains Blaney. "The transfusion of the stem cells isn't much different from other blood transfusions. If they've had chemo they know what to expect. The side effects of both procedures are similar, but the good news is that with non-myeloablative conditioning regimens (an allogeneic procedure), organ damage and mouth sores are often less of a problem for BMT patients."

What surprises patients most is the recovery: "The procedure is exhausting and the recovery tends to be slow. I'm conservative when I tell patients not to expect a full recovery for six months to a year," says Blaney, who has more than 20 years' experience working with transplant patients. Generally, transplants with autologous cells have a faster recovery; allogeneic transplants are more complicated. "We don't know how the new immune system will affect the patient. There can be different side effects and patients are closely monitored."

Choosing a Center

There are a number of factors potential BMT patients should consider. One of the most important ones, according to Blaney, is selection of the transplant center. Experts at the National Institutes of Health recommend comparing the survival statistics at different centers when considering your options, but Blaney urges patients to focus on the relevant statistics. "Be sure you are comparing apples to apples and looking at numbers that mean something to you," she advises. "In other words, be sure the statistics are specific to your age and particular disease."

This may seem obvious, but finding the information can be a difficult task, Blaney says: "Say the transplant center is small and performs only 50 transplants in a year, and one person has a bad outcome. That gives the impression the center has a low survival rate."

Alternatively, there may not be survival statistics for your specific disease. "If that's the case, statistics about your disease have probably been combined with other diseases and [the information] will be difficult to tease out."

The location of the transplant center is also important, especially since follow-up care can differ from center to center. Memorial Sloan Kettering Cancer Center in New York City, for example, requires patients to stay near the hospital for 100 days following the transplant. But in Rochester, where Blaney works, the transplant team doesn't require close proximity unless there is a medical need. "We've developed good relationships with community oncologists and are in close contact with all of them. Patients still follow up with us regularly, but we try to work with their local oncologist if they are comfortable seeing the patient."

Finally, one of the most important factors in choosing a center is comfort level. "First and foremost, a patient should feel supported and comfortable with her caregivers," says Blaney.

In terms of follow-up care, a patient who receives a donor's cells would return to the transplant center at least once a week, but it's not unusual to return twice a week or more, and this will continue for several months.

Consider These Questions

If you're thinking of having a bone marrow transplant at a particular center, you may want to ask the following questions:

  • Do patients see the same transplant doctor or is there an alternating team of physicians during the process?
  • What is the average length of hospital stay?
  • What are the visitor policies? If you have children, you'll want to find out if they are allowed to visit. In some hospitals married spouses can spend the night.
  • Getting a hospital infection during the transplant procedure can be very dangerous. What are the center's infection control measures?
  • What about follow up care? How does the center stay in contact with the primary care doctor post-transplant?
  • If the patient is a child, can his schooling be continued at the center through tutoring services?

There's no question about it: being advised to have a BMT is unsettling. "Patients are trying to make an important decision while at the same time grieving the news of their diagnosis or results of treatment," says Blaney. "It can be a sad time for a lot of people, but there is a lot of hope in the process." That may be in part because in many cases, bone marrow transplants can significantly extend a patient's life. "For leukemia patients in particular, there is a chance the procedure will cure the disease. Many patients are grateful for the opportunity to have more meaningful time to spend with loved ones. A BMT can offer them that."

Meg Blaney, RN, reviewed this article.