Bone Marrow Transplant

Blood marrow transplants transfer healthy blood-forming cells from a donor into a person with blood cancer, such as leukemia and lymphoma. These donor cells grow into healthy white and red blood cells and platelets.

How the bone marrow functions Hematopoietic stem cells are found in the peripheral blood and the bone marrow, which is the soft, spongy center of your bone. These stem cells develop into all types of blood cells, including white blood cells, red blood cells, and platelets. White blood cells of various kinds make up part of your immune system for fighting infections. Red blood cells are responsible for carrying oxygen throughout your body. Platelets clot your blood to prevent bleeding. Stem cells are constantly being produced by your bone marrow and will develop into the types of cells your body needs.

Types of bone marrow transplants Most people who need to undergo a blood or marrow transplant have cancer, such as leukemia, lymphoma or multiple myeloma. There are different types of transplants. The type and severity of your disease determine what type of transplant you will need. An allogeneic transplant involves receiving donor bone marrow, umbilical cord stem cells, or peripheral stem cells. This donor is genetically matched and can be related or unrelated to you. An autologous transplant involves receiving your own peripheral blood stem cells. A syngeneic transplant involves receiving your identical twin's bone marrow or peripheral stem cells.

Why do I need to have bone marrow pre-transplant evaluation tests?

Your pre-transplant evaluation includes a variety of medical tests that provide complete information about your overall health. These medical tests help the bone marrow transplant team identify any potential problems before your transplant and avoid potential complications after your transplant.

While each patient does not have the same tests, most of the tests included in this handout are common for all transplant patients. The tests required before the transplant are usually done on an outpatient basis. Your nurse and administrative coordinator will help arrange these for you. Please ask your nurse coordinator any questions you have.

If special instructions are required before any of these tests, you will receive a written form that explains how to prepare. After the tests are completed, your doctor will review the results with you. These results are also required by your insurance company in order to approve the medical necessity of your transplant.

Blood tests

Your health care provider or a technician will take a sample of blood from your arm or central venous catheter (if one is in place). The blood is sent to a lab where the following tests are performed:

- Tissue typing (needed for allogeneic patients only)

This was done at or before your initial consultation appointment with your BMT doctor. Tissue typing is a series of blood tests that evaluate the compatibility or closeness of tissue between the organ donor and recipient. From your blood samples, the tissue typing lab can identify and compare information about your antigens (the “markers” in cells that stimulate antibody production) so they can match a bone marrow donor to you. All donors are carefully screened to prevent any transmissible diseases or detect other medical problems that might prevent them from donating bone marrow.

Other blood tests

In the laboratory, a series of tests will be performed to detect certain substances in your blood and to evaluate your general health. These blood tests might include:

Infectious disease screening for:

- Hepatitis

- HIV (human immunodeficiency virus)

- RPR (syphilis)

- Toxoplasmosis

- Varicella Zoster

- CMV (cytomegalovirus)

- EBV (Epstein-Barr virus)

- HSV (Herpes Simplex virus)

- West Nile Virus

- HTLV1/11 (Human T-Cell lymphotropic virus

- Chagas

- Blood work to check your organ function

- Ferritin

- Pregnancy test

- Complete Metabolic Panel

- Hemoglobin solubility

- ABO blood type

- Bleeding times

- CBC, diff, platelets

- Quantitative immunoglobulins

- Other possible blood work

- Disease-specific labs for multiple myeloma

- Research samples

Other tests:

-Chest X-ray

A chest X-ray provides a picture of your heart and lungs. This X-ray provides information about the size of your heart and lungs, and might detect the presence of lung disease or infection.

Pulmonary function tests (PFTs, lung tests)

Pulmonary function tests measure the capacity and function of your lungs, as well as your blood’s ability to carry oxygen. During the tests, you will be asked to breathe into a device called a spirometer.

Here are some guidelines to follow before your scheduled pulmonary function tests:

- Be sure to get plenty of sleep the night before.

- Plan to wear loose clothing during the test so you can give your greatest breathing effort.

- Limit your liquids and eat a light meal before the test. Drinking or eating too much before the test might make you feel bloated and unable to breathe deeply.

- Computed tomography scan (CT Scan)

A CT scan, uses X-rays and computers to produce a detailed image of the body. Depending on the type of scan you need, an oral and/or IV contrast material might be used so the radiologist can see the extent of your disease. CT scans also might reveal the presence of other abnormalities.

If you had a CT scan within 6 months before your pre-transplant evaluation, bring the CT scan films or disc, along with a copy of the report with you. The radiologist will use them as comparison when reading these new scans.

Depending on your illness, your doctor might order additional CT scans.

Positron emission tomography (PET) scan

A PET scan is a unique type of imaging test that helps doctors see how the organs and tissues inside your body are actually functioning.

The test involves injecting a very small dose of radioactive chemical, called a radiotracer, into a vein. The tracer travels through the body and is absorbed by the organs and tissues being studied. Next, you will be asked to lie down on a flat examination table that is moved into the center of a PET scanner -- a doughnut-like shaped machine. This machine detects and records the energy given off by the tracer substance. The PET scan can measure such vital function as glucose metabolism, which helps doctors identify abnormal from normal functioning organs and tissues.

One of the main differences between PET scans and other imaging tests like CT scan or magnetic resonance imaging (MRI) is that the PET scan reveals the cellular level metabolism changes occurring in an organ or tissue, or the activity of cells.

Depending on your illness, your doctor may order a PET scan.

Heart tests

Because prior chemotherapy and/or radiation therapy and the chemotherapy/ radiation therapy you will receive for transplant can affect your heart, you will need heart tests to identify and treat any potential problems before the transplant procedure. The heart tests include:

Electrocardiogram (EKG): An EKG is used to evaluate your heart rhythm. Before the test, electrodes (small, flat, sticky patches) are placed on your chest. The electrodes are attached to an electrocardiograph monitor that charts your heart’s electrical activity (heart rhythm).

Echocardiogram: An echocardiogram is a graphic outline of your heart’s movement. During the test, a wand, or transducer, is placed on your chest. The transducer emits ultrasound (high-frequency sound wave) vibrations so the doctor can see the outline of the heart’s movement. The echocardiogram provides pictures of the heart’s valves and chambers so the pumping action of the heart can be evaluated. Echocardiogram is often combined with Doppler ultrasound to evaluate blood flow across the heart’s valves.

Bone marrow biopsy

A bone marrow biopsy is performed to evaluate your marrow’s function and to assess for disease involvement. A needle is placed in your posterior hip bone to remove a sample of bone marrow. The area will be numbed with a local anesthetic, or pain-relieving medicine, to make you feel less discomfort during the procedure. You might be given oral medicine to help you relax prior to the procedure. You should plan to have a driver take you home after this procedure since the medicine can make you drowsy.

Skeletal survey

This is a series of X-rays of the skull and long bones to assess disease involvement for patients with multiple myeloma.

Other tests may be required by your insurance company or your physician, for example: colonoscopy, PAP smear, dental exam, or mammograms.

Additional tests

After the pre-transplant evaluation appointment, the BMT team may decide if you will need any other tests. Additional tests or consultations will be performed at Cleveland Clinic. Your nurse and administrative coordinator will help you make these arrangements.

After my bone marrow pre-transplant evaluation

At the end of your pre-transplant evaluation and after the test results are complete, the bone marrow transplant doctor will decide whether or not a bone marrow transplant is the appropriate treatment for you.

Your test results will also be sent to your insurance company for the insurance approval process. Usually the insurance company will make a determination in 7 to 10 days after receiving the test results.

Please understand that abnormal test results might require further investigation.

The goal of pre-transplant testing is to ensure that you will be able to undergo the transplant and recover without increased risk of complications.

Bone marrow donor pre-transplant testing

For allogeneic and mini-allogeneic transplant patients, your bone marrow donor will also have a medical evaluation with many of the same tests. The donor must be cleared and determined medically fit to proceed as your donor.