Advances in the treatment of cancer and improvements in supportive care over the past 10 years have improved the results and tolerability of blood and marrow transplants (BMT). 然而，BMT仍然是一个主要的程序. 同种异体移植, the patient receives bone marrow or blood stem cells from a tissue-matched (HLA-matched) donor who may or may not be a relative. 同卵双生异基因移植称为同基因移植.
同种异体移植
准备
You will be admitted to the hospital on the day your high-dose preparative therapy begins. Your admission date may be changed based on your health status or bed availability. 你住院的时间大约是四到六个星期.
过程
高剂量化疗
化疗在你住院后不久就开始了. 你的利来登录会讨论你将要服用的所有药物以及它们的副作用. Your nurse practitioner, inpatient nurse and pharmacist also will be available to answer questions. 此外，您可能会在同意书中收到有关这些药物的书面信息.
采取预防措施以尽量减少这些药物的副作用. 例如, 当接受某些类型的化疗时, patients must shower thoroughly twice a day to remove the drug that is excreted through the skin – this is done to help prevent or minimize chemotherapy burns. The inpatient nurse will go over any other special precautions that you may need to take.
全身辐照
一些病人接受全身放射治疗(TBI)在化疗之外. This radiation therapy is intended to destroy remaining cancer cells and further suppress the immune system.
TBI treatments are given in the radiotherapy department, usually over a period of three to four days. 治疗本身是无痛的, 但治疗后可能会有不舒服的副作用, 比如口腔和喉咙痛, 恶心想吐, 肠胃不适, 和皮肤发红. 每次治疗前通常给药以减轻恶心.
移植过程
The transplant of blood stem cells or bone marrow will be infused one to three days after the last chemotherapy or radiation dose. 移植的这一天被称为第0天. The days before the transplant are counted as minus days and the days after the transplant are plus days.
The transplant procedure is similar to a simple blood transfusion and will be done in your hospital room. 如果你愿意，你的家人可以和你一起在房间里. The actual procedure will take approximately one hour, depending on the volume of stem cells. The blood stem cells will be infused through your central venous catheter just like a regular blood transfusion. 你的护士会给你量血压, 温度, 呼吸和脉搏, 会留意任何副作用.
通常没有副作用, 但偶尔病人也会感到寒战, 脸红, 恶心和呕吐, 头疼, 还有血压和呼吸的变化. 你的尿液也可能在移植后的24小时内呈微红色. 如果你的尿液在这段时间后仍然是红色的，或以后变成红色，告诉你的护士.
继续阅读
等待移植
新的骨髓在被移植后不会立即恢复. 被移植的骨髓中的干细胞将到达骨头, 重新播种骨髓空间, and go through a growth process before the mature cells are released from the bone marrow into the blood stream. It takes approximately two to three weeks for your marrow to start producing white blood cells, 红细胞和血小板.
Engraftment is the term used to describe when your new marrow begins to function and produce blood cells. While awaiting engraftment, no mature cells leave the marrow and enter the blood stream. Your blood counts will show very low values and you will require careful monitoring by the health care team. The goal is to support you with red blood cell and platelet transfusion until you are producing cells again. You will also need antibiotics to prevent infections from bacteria, fungi and viruses.
复苏
延迟的副作用
The body feels the effects of the chemotherapy or radiation about a week after a BMT. When the blood counts are low, you feel like you have the flu and may not want to do much. 这将持续大约两周，随着你的血液计数的改善，它将减少. 您可能还会注意到一些其他症状，包括:
- 食欲不振
- 恶心和呕吐
- 视觉的变化
- 口腔和咽喉疼痛
- 腹泻
- 睡眠困难和疲劳
- 感染
- 脱发
- 皮肤反应
- 移植物抗宿主病
准备离开利来登录
When your neutrophil count is rising, your team will start talking to you about discharge. You will need to be sure that arrangements have been made for someone to stay with you after you are discharged, to assist you with daily needs and to be available for clinic visit transportation. You and a family member will learn how to care for your catheter and all about your medications.
要出院，你需要:
- 走
- 每天摄入至少1000卡路里
- 每天至少喝一夸脱的液体
- 没有健康问题
- 没有发烧
- 不用静脉注射药物，吃药也没问题
- 证明你能照顾好你的静脉导管
个案经理将协助安排家庭护理. The nurse practitioner will go over your discharge and outpatient instructions and the pharmacist will review your medications with you.
常规门诊访问
Your BMT doctor and nurse practitioner will follow you closely after your transplant. You will have blood work done and, if necessary, will be given intravenous medications or fluids. Expect to be in the Hematology/BMT Clinic twice a week for at least two to three months.
保持健康
Your risk of infection will remain higher than normal for at least six to 12 months after allogeneic BMT even though your body is again producing white blood cells. 你将被指导如何帮助预防感染, 包括洗手, 避开人群，避免吸烟或吸食大麻.
照顾者的角色
All patients undergoing an allogeneic bone marrow or stem cell transplant are required to have an identified person who can assist them after they are discharged from the hospital. 我们称这个人为“看护者”." In order to be approved for an allogeneic BMT each patient must identify a person or persons who can fulfill the responsibilities of the caregiver, 其中包括:
- 提供情感支持
- 提供物质支持
- 收集和报告信息
- 中心静脉导管的护理
- 管理和理解药物
加州大学旧金山分校健康医学专家已经审阅了这一信息. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
