Treatment
How is a transplant given?
In preparation for transplant a person’s immune system will be wiped out by high dose chemotherapy and sometimes radiotherapy treatment. This often has the effect of killing off residual cancer cells and is the aim of the treatment. Once this treatment is complete the bone marrow or stem cells can be given via an intravenous drip. The stem cells do not start working straight away and can take up to a year to start working effectively and really protecting a person from infection.
The side effects of such high dose treatment are severe. A person is not able to produce their own red, white blood cells or platelets and the transplanted tissue is unable to do this for some time either. This means they need regular support with blood and platelet transfusions to prevent bleeding and control anaemia. Transfusions of white cells to control infection cannot be given and so despite antibiotics they are at very high risk of life threatening infection with normally innocuous bacteria or viruses. When a person is unable to produce their own white blood cells to fight infection this is called ‘neutropenia’. The high risk period after transplant when a person is very vulnerable to infection is called the ‘neutropenic period’ – the neutropenic period is usually spent in hospital.
Once some improvement has occurred and the immune system has started to work to a degree they will be discharged from hospital. The person undergoing treatment is likely to feel extremely ill and weak and may sleep for most of the time. They will have many of the side effects of chemotherapy.
Often the first phase of treatment will be given in isolation in hospital – isolation means just that, a person is kept in one room with minimal visitors who all wear barrier clothing to prevent the transfer of infection. The psychological effects of isolation can be severe. The time spent in isolation in the recent past was 1-2 months. This time has been reduced with more of the recovery time spent at home. The same precautions may be necessary at home as would be taken in an isolation room in hospital. These may be troublesome for carers in terms of cleanliness of the home, providing safe food, preventing contact with potentially harmful everyday items and restricting access to people who are themselves unwell. In addition frequent blood tests are needed to monitor progress and this is likely to involve accompanying their family member to hospital and back.
Amended February 2009
