The preparation phase begins when the patient arrives at the treatment center and begins the process of medical evaluation, orientation, informed consent, and other preliminary activities. Family members will be educated to assume the caregiver role.
Beginning Medical Evaluation
The outpatient evaluation or "work-up" may last from two to 10 days, depending
on the number of tests that were performed prior to arrival, the complexity
of the tests, and the clinical decisions that arise when the results are compiled.
Conference For Treatment Plan
After the medical evaluation has been completed, a conference will be held to
discuss the findings. In the conference, the individualized treatment plan will
be discussed. Informed consent will be obtained. This is a shared decision-making
process between the patient and the health care provider. Included in the conference
will be a discussion about the nature and character of the proposed treatment,
the anticipated results, the recognized alternative forms of treatment and the
risks.
Patient And Caregiver Classes
The education program for patients and their caregivers consists of classes,
individual instruction and reference materials. Classes are offered every week.
They include classes that teach how to give and record medications, and how
to monitor medications and fluids. Nutrition classes cover safety in food preparation
and management of nutrition problems at home. Throughout the transplant process,
a transition nurse will assist the patient and caregiver with home-care planning.
Central Venous Catheter Evaluation And Insertion
Prior to the start of the actual transplant process, a central venous access
catheter will be placed. The bone marrow or peripheral blood stem cells, hydrating
fluids, nutritional supplements, medications, and blood products will be administered
through this catheter as needed. Patients who arrive with a central venous catheter
already in place will have the catheter assessed by the transplant team and
a decision will be made to either use the existing catheter or to replace it.
Bone-Marrow Harvest
A bone marrow harvest is a surgical procedure requiring general or spinal anesthesia.
Multiple aspirations from the crests of the pelvic bone will be performed. If
the marrow is to be used for an autologous transplant, it will be cryopreserved
(frozen) and stored. If the marrow is to be used for an allogeneic transplant,
the marrow will be infused within 24 hours of harvest.
Stem-Cell Collection
The process of collecting peripheral blood stem cells is divided into three
stages: mobilization, collection and reinfusion. Mobilization is accomplished
by administration of medication that causes the stem cells to leave the tissues
they normally occupy and to circulate in the bloodstream. These cells are then
collected using a pheresis machine. Once pheresed, autologous stem cells are
cryopreserved, while allogeneic stem cells are infused immediately.
Getting To Know Your Providers
In 1998, Fred Hutchinson Cancer Research Center, University of Washington Medicine and
Children's Hospital and Regional Medical Center formed
the Seattle Cancer Care Alliance (SCCA).
The SCCA provides the patient care for the oncology-based programs at the partner
organizations. Patients being treated through the Fred Hutchinson Cancer Research
Center Bone Marrow Transplant Program will be admitted to the SCCA.
Patients will be exposed to different teams as they move between the SCCA outpatient and inpatient settings. Every patient has an "attending physician." These doctors are staff members at Fred Hutchinson, the University of Washington and Children's, and all are very experienced in transplantation. In addition, the patient will have a primary physician who is the doctor who will give the patient the most direct care. SCCA registered nurses, who are specially trained to care for transplant patients, staff both the outpatient and inpatient units. All of these team members are valuable resources for answering patient or family questions.
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