The Autologous Transplant Team works as an interdisciplinary team. Your doctor, the one you see in the clinic, will be in charge of your care throughout your treatment. However, your doctor may not be the one to manage your day-today care while you are in the hospital. Attending doctors rotate on the inpatient unit. One attending will be responsible for your care for 2 weeks before another attending takes over. Any important decisions are made with your doctor.
Fellows, nurse practitioners, hospitalists and house staff are also partners in your care. The fellow is an internist doing special training in cancer. A nurse practitioner is a nurse who has an advanced degree in an area of care. This nurse practitioner can take patient histories, do physical exams, and prescribe treatments and medicine. He or she can also provide medical care with the doctors. The hospitalist is a doctor who only sees patients in the hospital. He or she will cover the unit at night. House staff are doctors who are completing their residency. They work under the supervision of the fellows and attending doctors. While you are here, you will come to know all of the members of your team. You can always contact your doctor if you have any questions. A team of primary nurses will be responsible for your day-to-day nursing care.
Before Your Treatment Starts
Diet
There is no special diet preparation before a stem cell transplant. You do not have to take a lot of vitamins. If you are under- or overweight, try to get to your normal weight before you come into the hospital. Your doctor can guide you with this effort.
Preserving Fertility
Many cancer treatments can affect fertility, the ability to have children. You may be infertile from the treatment you have already received. If not, you will most likely be infertile after your transplant treatment. This will have no effect on your ability to have sex. However, some patients report that they have a decrease in their sex drive.
There may be options for you to preserve your fertility before your transplant treatment begins. This must be done before you come into the hospital.
Men can preserve their fertility by sperm banking. This involves collecting, freezing, and storing sperm. Generally, three collections are needed. There are sperm banks throughout the U.S. where you can do this. To get more information about sperm banking, ask your doctor or nurse for our book “Fertility and Cancer Treatment: Information for Men,” and for our list of local sperm banks.
There are also options for women to preserve their fertility. This involves taking hormones for about 10-14 days and collecting eggs. The eggs may be fertilized with sperm to create embryos. The embryos or eggs are then frozen and stored. Because of the extra time this takes, you must discuss this with you doctor. To learn more about egg or embryo freezing, ask your doctor or nurse for local fertility doctor recommendations.
Radiation Simulation
If you are going to have radiation as part of your treatment, you will meet with the radiation therapy team before you are admitted. You may also have a CT scan or PET scan or both to plan your treatment. You will also have a planning session called simulation. During this session, several x-rays are taken along with measurements of your chest. These are used to make lead shields. Your lungs are very sensitive to radiation and the shields will be used to protect them during some of the treatments.
Dental Exam
You will have a dental exam. Decayed teeth and gums can cause serious infections in patients being treated with high doses of chemo or radiation. We must be sure that anything that could cause an infection in your mouth is fixed before your transplant. For example, you may need cavities filled, loose fillings replaced, or gum disease treated. Mouth care will be very important for the entire time you are in the hospital. We have an oral health clinic at UAMS who can assist you if you do not have a family dentist.
A Central Venous IV Catheter/Central Line
A central venous IV catheter is an intravenous (IV) line (Central Line) that can stay in place for many months. Hickman, Cook, Quinton catheters are examples of central venous IV catheters. You will need to have one of these because fluids, medicines, blood products, and stem cells are given through it. Most, but not all, blood samples can also be drawn from the catheter. Central venous catheters are usually placed the day of admission or several days before. Some are removed before discharge. However, some patients go home with the catheter in place. If you go home with it, your nurse will teach you, a family member, or both, how to care for it. Tests
Before your treatment starts, you will have some tests done. These will tell us how your body is functioning and what the status of your cancer or bone marrow disease is. We will use the test results to watch for any changes during treatment. You will have some, or possibly all of the following tests.
- Chest x-ray – Blood tests
- Urine test
- A pregnancy test, if appropriate
- Electrocardiogram (EKG), echocardiogram (ECHO), MUGA scan – These tests tell us how your heart is functioning.
- Pulmonary function tests (PFTs) – These are breathing tests to see how well your lungs work.
- CT or PET scan – These scans may be used to see where tumors are in your body, to plan your radiation treatments, or both.
- Bone marrow biopsy – This gives us a sample of your bone marrow. It will tell us about the state of your blood cells. It is done before your transplant, three to four weeks after your transplant, and then every three months for the first year. The timing may vary.
- Lumbar puncture (spinal tap) – This lets us check for abnormal cells in your spinal fluid. A small needle is inserted through your back and a small amount of fluid is withdrawn. A lumbar puncture is only done for certain types of leukemia.
Your doctor or nurse will explain to you any other tests you may need.