Preparing for Your Stem Cell or Bone Marrow Transplant

Entering the transplant program in the best possible health maximizes your chances at a facorable outcome and lowers the risk of complications. At Hackensack University Medical Center we will coordinate care with your local hematologist-oncologist to prepare you for the transplant.

The following exams are a necessary part of your pre- transplant work-up. Our team suggests that you schedule an appointment with your dentist or gynecologist for these exams and any related follow-up work needed, as soon as possible. We will advise you as to what is an appropriate time to have such exams and work done, depending on your treatment regimen and blood counts.

Examinations
Dental Exam:
You will need to have a complete dental exam before your transplant. Decaying teeth and gums can be a common source of serious infection in patients receiving high doses of chemotherapy and/or radiation therapy. Your dentist/ hygienist may need to take a full set of dental X-rays (Panorex) and perform a thorough cleaning and scaling of your teeth and gums. Your dentist will need to meticulously examine your gums. Any potential sources of oral infection, such as abscesses will need to be treated before transplant.

A letter or phone call from your dentist to the Stem Cell Transplant office (201-996-5849) will be necessary stating you are cleared and that any identified problems have been resolved. Mouth care will remain very important throughout your transplant course. Many dentists also recommend that oncology patients treated with chemotherapy and/or radiation have mouth trays made for them to provide fluoride treatments. Many transplant patients experience a decrease in saliva production which, subsequently, allows food and bacteria to remain in the mouth rather than being washed away with saliva. This can lead to serious dental decay. Fluoride treatments can help prevent such decay. We suggest that you discuss this with your dentist and decide what is best for you.

Gynecological Exam:
All female patients need a gynecological exam before transplant. The vagina, cervix, and uterus are possible sites of infection and hemorrhage. It is necessary to treat any possible problems noted before the transplant. Cultures may need to be obtained if any signs of infection such as a rash or discharge are noted. A Pap Smear is not required, as abnormal results are common in patients receiving chemotherapy. A letter or phone call from your gynecologist to the Stem Cell Transplant office (201-996-5849) will be needed stating you are cleared and that any identified problems have been resolved. During your transplant hospitalization, your doctor may place you on hormonal therapy, individualized to your cycle, to temporarily suppress your menstrual cycle (periods) and prevent any vaginal bleeding. Good personal hygiene will remain very important throughout your treatment and recovery.

Sperm Banking:
Sterility (being unable to have children) can result from the use of total body irradiation (TBI) and high dose chemotherapy. The ability to engage in sexual activity is not affected by these treatments. Men interested in sperm banking should ask their doctor for further details and investigate the feasibility of sperm banking before admission to the hospital. There are sperm bank centers throughout the country.

Diet:
No special diet is required to prepare for transplantation. It is not necessary to increase vitamin intake or to gain weight. Our dietary, medical, and nursing staff will help you maintain your nutritional balance. However, if your are currently over- or under- weight, you should attempt, with your physician's guidance, to achieve your normal weight before admission.

Tests
Before the actual transplant, various diagnostic tests and exams will need to be performed. Most of these tests will be done prior to admission for transplant. The results of these tests establish baseline information and are used to tell us how your body is presently functioning and to evaluate any changes that occur during or after transplantation.

Some of the tests you may undergo include (but are not limited to):

Audiogram:
A hearing test to determine the threshold of hearing at various sound frequencies.

Blood Tests:
Numerous blood specimens are drawn to determine blood counts and the chemical composition of your blood. These tests and others will be repeated frequently throughout hospitalization.

Bone Marrow Aspiration and Biopsy:
Provides a sample of your bone marrow

Bone Scan:
An imaging study of your bones. Requires an injection of dye into your vein first, followed by the actual scan two hours later.

Chest X-ray:
An X-ray of your chest, showing your lungs, heart, and ribs.

Cardiac (MUGA) Scan:
A test which measures how well your heart is functioning.

Computerized Axial Tomography (CAT Scan):
A special X-ray that provides cross-sectional views and images of soft tissues as well as bone. It provides measurements of your chest and is used to plan radiation treatments if necessary.

Electrocardiogram (EKG):
A tracing of electrical activity of the heart.

Echocardiogram:
A record of the size and motion of the heart.

Magnetic Resonance Imaging (MRI):
A special imaging test utilized similarly to a CAT scan.

Pulmonary Function Tests (PFT's):
Breathing tests to assess lung function.

Urinalysis:
Analysis of a urine sample.