Pre-transplant evaluation
The consultation visit:
More detailed information here about what happens during
the "first appointment," and a list of suggested questions you may want to ask »
After patients are referred for consideration of a stem cell transplant, the patients and families are scheduled for an initial consultation visit. Several meetings with the stem cell transplant team are held to discuss the process of stem cell transplant,
side effects and complications. The stem cell transplant team also verifies that the patient is eligible for a stem cell transplant. In order to evaluate patients, their medical record,
imaging studies (xrays, CT scans, etc) and pathology slides are reviewed. The transplant coordinator helps to obtain these if patients have been treated at a hospital other than Children's Memorial.
Pre-stem cell transplant evaluation:
Children's health before a transplant can affect how well their bodies recover afterwards. The pre-stem cell transplant evaluation is done to assess children's disease status and their general health to make sure they are eligible for stem cell transplantation. Infections and disease status are two factors that could cause the transplant to be postponed or potentially cancelled. The pre-stem cell transplant evaluation is done within 30 days of the transplant. The evaluation helps the team determine if the heart, lungs, kidneys and liver will tolerate the side effects of chemotherapy and/or radiation used during the transplant. Some of the tests included in the pre-stem cell transplant evaluation include:
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Blood tests: Evaluation of blood, marrow, immune function, organ function, viral status and infectious disease status
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Disease status: If the patient is being treated for a blood-related
cancer or disease, a
bone marrow aspiration and biopsy and
lumbar puncture are done to confirm that the child's disease is in
remission. If patients are being treated for
lymphoma or other solid tumors, they may have a positron emission tomography (PET) scan, computed tomography (CT scan) or gallium scan to find out how active the disease is.
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Chest
x-ray and
sinus x-ray: Evaluates for infections or other problems in the lungs or sinuses.
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Echocardiogram (
ultrasound of heart): Evaluates how well the patient's heart is pumping.
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Pulmonary function tests: Evaluates how well the lungs are functioning.
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Audiology tests (hearing test): Evaluates the patient's hearing
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Dental evaluation: To make sure that teeth are healthy because post-transplant infections are common
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The pre-stem cell transplant evaluations are specific to the patient's disease and age, and are performed on an outpatient basis. It may take from two to 10 days to complete the evaluation, depending on the number of tests that are needed, the complexity of the tests, and the clinical decisions to be made when all of the results at finalized.
Most patients need to have a double or triple lumen PICC line (peripherally inserted central catheter) or central line (port or broviac) placed before starting the stem cell transplant. The central line is needed for administration of chemotherapy, to give the bone marrow or peripheral blood stem cells, for medications and blood product transfusions the patient needs without inserting needles into the patient's arms or hands.
Before the treatment begins, patients and their families meet with the transplant physician to review their child's disease status and transplant treatment plan. This conference includes the reasons why the stem cell transplant is recommended; the risks and benefits of any research study being offered and alternatives to the research studies. Before patients are enrolled in any study, their parents or guardians must give consent and sign an Institutional Review Board (IRB)-approved informed consent document. Children who are 12 years of age or older must provide assent. Patients receive a copy of the signed informed consent document for their reference during the transplantation process.