Overview
The spongy tissue inside your bones, called bone marrow, contains stem cells. Those stem cells make your body's blood cells. These cells include red blood cells, white blood cells and platelets. Without bone marrow and stem cells working properly, your body can't make the blood cells it needs.
A bone marrow transplant, also called a stem cell transplant, places healthy stem cells into your body if your bone marrow stops working and does not make enough functional blood cells.
Video: cómo funciona el trasplante de células madre
La médula ósea es el tejido esponjoso que hay dentro de algunos huesos. Su función es producir células sanguíneas. Si tu médula ósea no está funcionando adecuadamente debido a un cáncer u otra enfermedad, puedes recibir un trasplante de células madre.
A fin de prepararte para un trasplante de células madre, recibes quimioterapia con el objetivo de destruir las células afectadas por la enfermedad y la médula ósea que funciona mal. Luego, las células madre sanguíneas trasplantadas se introducen en el torrente sanguíneo. Las células madre trasplantadas encuentran su camino hacia la médula, donde, idealmente, comienzan a producir células sanguíneas nuevas y sanas.
The procedure weakens your immune system, making you more susceptible to viral and bacterial infections for a period of time. Traditionally, hospitals require people who have bone marrow transplants to stay in the hospital during treatment and the early stages of recovery. Depending on the type of transplant, this stay may last from a week or two to as long as a month.
Because long hospital stays can be hard, Mayo Clinic offers outpatient bone marrow transplants for people with certain conditions. With an outpatient transplant, you receive the same effective treatment but return home or to nearby lodging each night.
Through an outpatient bone marrow transplant, also called an ambulatory bone marrow transplant, you stay closely connected to Mayo Clinic. For instance, for the first 1 to 2 weeks, you visit the transplant center each day. Your care team provides the treatment you need and closely monitors your condition. After your recovery and when certain criteria are met, you return to the comfort of your own home.
How outpatient bone marrow transplant works
An outpatient stem cell transplant usually takes 2 to 3 weeks to complete. A team of specialists, with expertise across the transplant process, performs each phase at Mayo Clinic. Outpatient bone marrow transplant phases include:
- Collection. If you're getting a transplant using your own stem cells, healthy stem cells are collected from your body to be given back to you later. Most often the stem cells are collected from your bloodstream. It may take 2 to 3 sessions over a few days to get enough cells for your transplant. Rarely, the stem cells are taken from your bone marrow.
- Conditioning. Radiation, chemotherapy or both kill cells and bone marrow that aren't working properly. Conditioning prepares your bone marrow for the new stem cells. Conditioning also weakens your immune system to make it less likely that your body rejects the new stem cells if you get them from a donor.
- Infusion. The collected stem cells are put into your bloodstream. The transplanted stem cells find their way to your bone marrow. There, they begin making new, healthy blood cells.
- Recovery. It takes a few weeks for the new cells to settle in your bone marrow and begin making new cells, a process called engraftment. Until the new, working stem cells start making new blood cells, you may need blood transfusions.
In the days and weeks after your bone marrow transplant, you have blood tests and other tests to monitor your condition. You have daily visits with your care team to watch for side effects and to see how your body responds to the transplant. Your care team checks your blood often to see how many new blood cells your bone marrow is making.
If you do not live within a 30-minute drive, you may need to rent an apartment or book a hotel room nearby.
Types of bone marrow transplant that can be done in an outpatient setting
Mayo Clinic offers bone marrow transplants for adults and children using autologous transplant and allogeneic transplant.
- Autologous stem cell transplant. This type of bone marrow transplant uses your own blood stem cells to replace bone marrow. Autologous stem cell transplant, also called autologous bone marrow transplant, might be an option if your body is making some healthy bone marrow cells. Those cells can be collected, frozen and stored to give back to you later.
- Allogeneic stem cell transplant. This type of bone marrow transplant uses stem cells from a donor, such as a family member, a donor not related to you or umbilical cord blood. The donor cells must match your cells genetically. An allogeneic stem cell transplant, also called an allogenic bone marrow transplant, uses healthy blood stem cells to replace bone marrow that does not make healthy blood cells or to help treat a blood cancer.
Benefits of outpatient bone marrow transplant
Bone marrow transplant done during a hospital stay or on an outpatient basis are both safe and effective treatments for several blood disorders. Both methods offer close daily monitoring by a bone marrow transplant care team.
Outpatient bone marrow transplant offers some advantages over bone marrow transplant done during a hospital stay:
- You can return to the comfort of your home — or temporary nearby home — overnight after your daily outpatient transplant center visit.
- You can spend more time with family and friends for support.
- You're more likely to be out of bed for longer periods of time, which can help you keep your strength.
- You can go back to outpatient treatment even if you need a brief hospital stay.
Studies of outpatient compared with inpatient bone marrow transplant show that the outpatient setting offers:
- Fewer days in the hospital, which lowers hospital cost.
- Lower risk of getting infections related to a hospital stay.
- Generally better satisfaction with the experience through transplantation.
- Access to bone marrow transplant care for more people because hospital rooms are less used.
Eligibility
Your care team may consider you for an outpatient bone marrow transplant if you have a blood condition that can be treated this way. You also need to be healthy enough to benefit from the transplant and recover at home. If you have other serious medical conditions, an outpatient stem cell transplant may not be a good choice for you.
Mayo Clinic experts evaluate each person and the specific condition to ensure an outpatient bone marrow transplant can be an effective option. The evaluation usually includes a number of tests and appointments over several days. Testing will likely include blood tests, testing of your organ function, and a bone marrow biopsy and aspiration.
If you have an ongoing infection, it needs to be resolved before a bone marrow transplant. If you have current issues with alcohol or drug misuse, or if you smoke, you may not be able to get a bone marrow transplant.
Outpatient bone marrow transplant may be an option for people who have:
Need for caregivers in outpatient bone marrow transplant
Because your immune system doesn't work properly during your treatment, you need a caregiver during and after a stem cell transplant. You may consider having more than one caregiver because someone must be with you 24 hours a day and go with you to all of your appointments. Most people need a caregiver for about 100 days after a stem cell transplant.
Your caregiver needs to be a responsible adult. Caregivers are usually a spouse, a parent, a sibling, an adult child or a friend.
Your committed caregiver plays a big part in a successful transplant. Your caregiver can take you to and from daily appointments and help you with your medicines, food preparation, household tasks and daily routine.
Your Mayo Clinic bone marrow transplant care team can give your caregiver information on caring for you. This can include ways to prevent infection and how to watch for signs of infection such as fever.
Your care team
During your outpatient bone marrow transplant, your team of experts takes every precaution to minimize the chances of complications. The goal throughout is to provide you the exact care you need, when you need it. Depending on your needs, your Mayo Clinic transplant care team may include:
- A bone marrow transplant coordinator dedicated to you.
- Cancer specialists, called oncologists.
- Chaplains.
- Child life specialists.
- Dietitians.
- Hematologists.
- Mental health specialists.
- Nurses who specialize in outpatient bone marrow transplants.
- Pharmacists.
- Physician assistants.
- Social workers.
- Transfusion medicine nurses.
If you have concerns or health issues when you're away from the transplant center, you can contact your outpatient bone marrow transplant team 24 hours a day, 7 days a week by phone or through the Mayo Clinic Patient Portal.
Why Mayo Clinic
Experts in the Mayo Clinic Bone Marrow Transplant Program have extensive experience using bone marrow transplants in both hospital and outpatient settings to treat a variety of cancers and noncancerous conditions. This team of bone marrow transplant specialists directs your care.
At Mayo Clinic, healthcare professionals who specialize in blood diseases, called hematologists, form a multispecialty team with other experts. Together, they provide personalized, whole-person bone marrow transplant care to adults and children. People who choose Mayo Clinic for their care receive comprehensive, compassionate and personalized attention from healthcare professionals and staff who are committed to providing exactly the care needed.
Learn more about the expertise of Mayo Clinic's Bone Marrow Transplant Program.
Lodging
When you have outpatient bone marrow transplant, prepare for an extended stay. You have daily visits to the outpatient bone marrow transplant unit for about 14 days during autologous transplantation or up to 28 days during allogeneic transplantation. After the transplant, you will need in-clinic follow up for 2 to 3 weeks for autologous transplantation or 2 months for allogeneic transplantation. So you need to stay close to your treatment center, usually no more than 45 minutes away. You also need to have reliable transportation to and from the transplant center.
If you do not live close to the transplant center, you must find local lodging, such as a nearby apartment or hotel.
If you are traveling from out of town, ask your Mayo Clinic bone marrow transplant care team about long-term housing. Team members can give you a list of cost-effective housing choices near the transplant center. Some options that may be available include the following:
The Village at Mayo Clinic in Phoenix, Arizona, offers low-cost housing for transplant patients and their caregivers.
The Gabriel House of Care in Jacksonville, Florida, offers low-cost housing for transplant patients and their caregivers.
The Gift of Life Transplant House in Rochester, Minnesota, offers low-cost housing for adult and pediatric transplant patients and their caregivers.
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