Definition and Overview
A bone marrow transplant follow-up is a post-transplant appointment between a patient and his healthcare team, which include an oncologist and hematologist (blood specialist).
A bone marrow transplant is a procedure where the marrow, or the fatty tissue found within the bone that is responsible for creating red and white blood cells, is replaced with a new one. Red blood cells are responsible for delivering oxygen to different parts of the body while the white blood cells have crucial components that help fight and provide immunity against pathogens and infections.
Many diseases can cause an abnormal level of blood cells. These include blood cancers like leukemia and blood disorders like severe anemia. Although medications and other forms of treatment such as chemotherapy and radiation can be used, a transplant is recommended for severe cases.
A bone marrow transplant may be autologous or allogeneic. The former means that the stem cells, which are used to generate the bone marrow, come from the patient himself. Allogeneic, on the other hand, means the stem cells come from another person. The best and most convenient matches are often direct family members such as parents and siblings. However, they can also be friends, distant relatives, and even strangers who can be found in donor registries.
Who Should Undergo and Expected Results
A bone marrow transplant follow-up is a requirement for all those who have gone through the procedure as there is a chance that complications may develop. Some of the most common ones are nausea and vomiting, chest pain, high fever, headache, chills, and shortness of breath. While some of the complications are mild, a number may be serious enough to decrease the patient’s level of activity and prevent essential functions like eating or swallowing.
In other cases, patients may develop allergies, which may be life threatening if it includes anaphylactic shock. Doctors also often watch out for a condition called graft-versus-host disease (GVHD), a condition wherein the transplanted stem cells destroy the tissues and organs of the body.
Also, a bone marrow transplant does not always guarantee a complete cure. It may only partially cure the disease, or it is possible that the disease itself can return even after the doctor has confirmed a complete cure. A follow-up is instrumental in monitoring recurrence, detecting it while in its earliest stages and treating it accordingly before it gets worse.
Children who have gone through a bone marrow transplant undergo follow-up not only to monitor complications and recurrence but also to track their growth and development.
How Does the Procedure Work?
The majority of patients who have gone through a bone marrow transplant require a long-term follow-up care. This is especially true for children who will still undergo many physiological changes while growing up.
The frequency of follow-ups depends on many factors including complications that have occurred following the procedure, the overall health of the patient including the state of his immune system, age and the presence of other physical conditions. Normally, patients who receive an autologous transplant will be checked as part of the ongoing follow-up a month after. Those who have allogeneic transplant may visit their transplant team after three months. After that, follow-up can be scheduled every six months then every year for at least five years.
Many hospitals these days have a comprehensive transplant program, which includes a dedicated long-term follow-up. A patient is provided with a nurse or a coordinator who sees to it that the patient commits and attends all his appointments. Depending on the progress of the patient, he may be released from the program and then continued to be monitored by the referring physician.
The follow-up is best conducted face-to-face. However, in times when that is not possible, such as when the patient is traveling, has moved to another state, or is ill, it can be performed through telephone or video conferencing and e-mail.
Possible Risks and Complications
A follow-up requires regular communication and a strong commitment from the patient. However, many factors may prevent the patient from being dedicated to it. These include the development of complications, age and general health condition. Some of the patients may feel that they are well enough that they do not need to visit their doctor regularly or often while others may be frustrated with their own health. A number of patients may also develop emotional health problems such as depression and anxiety, which can worsen or be triggered by follow-up visits.
Bashir Q, Champlin R. Hematopoietic stem cell transplantation. In: Niederhuber JE, Armitage JO, Doroshow JH, et al., eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2013:chap 30.
Heslop HE. Overview of hematopoietic stem cell transplantation. In: Hoffman R, Benz EJ Jr, Silberstein LE, Heslop HE, Weitz JI, Anastasi JI, eds. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 104.