自体移植

A bone marrow transplant physician will begin the evaluation by reviewing your medical record and history, 进行身体检查, 然后和你讨论一下手术过程. This visit will be your initial consult and will also include a bone marrow transplant coordinator, 谁会在整个过程中帮助你. 如果确定你适合自体干细胞移植, 治疗方案将会确定.

在被送进医院之前, you will have several days of laboratory and other diagnostic tests to determine if you have normal function of the heart, 肺, 肾脏和肝脏，并且你没有未确诊的感染. Most of these tests will be done as an outpatient before you are admitted to the hospital. 这些测试可能包括:

• 血液测试
• 尿检和/或24小时尿液收集
• 骨髓穿刺和活检
• 胸部x光片
• 肺功能检查(PFTs)
• CAT扫描/PET扫描
• 超声心动图
• 牙科考试

有了血管通道，健康团队就可以进行化疗, 其他药物, 血液制品甚至干细胞移植给你无痛. 也, the catheter will be used to withdraw samples for blood tests required during the course of treatment, 从而最大限度地减少将针插入手臂或手的需要. 在一般情况下, 导尿管在整个住院期间都存在, 一旦你不再需要它，你的计数恢复，它就会被移除.

Stem cells are found predominantly in the bone marrow but can be stimulated to travel out into the blood. When the stem cells are collected from the hip bone by performing many bone marrow aspirations, 哪些手术通常在手术室进行, 移植过程被称为骨髓移植. When the stem cells are collected from the blood after stimulating the stem cells with a hormone called G-CSF, 这种移植称为外周血干细胞移植. Currently, most transplant procedures involve collecting stem cells from the peripheral blood. 当骨髓或血液干细胞被注入受体时, they are administered through an intravenous catheter or central venous catheter just like a blood transfusion. 干细胞不能直接注入骨骼, 而是从血液流向骨骼.

• 外周血干细胞收集

The collection of stem cells from the marrow is a surgical procedure in a hospital operating room, 通常在全身麻醉下. 它风险很小，不适也最小. 在麻醉状态下, 一根针插入髋骨后的腔，称为髂骨, 大量的骨髓分布在哪里. 骨髓是一种粘稠的红色液体，用针和注射器提取. One or two punctures on each hip and multiple bone punctures are usually required to extract the bone marrow. There are no surgical incisions or stitches involved -- only skin punctures where the needle was inserted.

你将在化疗开始的那天住进医院. 您的入院日期可能会根据床位情况而改变. 你的住院时间将在两到四周之间.

化疗在你入院后不久就开始了. 你的医生会告诉你所有的药物和它们的副作用. Your transplant coordinator and inpatient nurse will be available to answer questions. 除了, you will receive written information on these drugs in the consent form.

已采取预防措施以尽量减少这些药物的副作用.

一些患者在化疗的同时接受全身照射(TBI). 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, 比如口腔和咽喉溃疡, 恶心想吐, 肠胃不适, 皮肤发红. 每次治疗前通常要服用止吐药以减轻恶心.

The transplant or stem cells will be infused one to two days after the last chemotherapy or radiation dose. 移植当天称为第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. 如果您愿意，您可以请一位家庭成员与您同住. The actual procedure will take approximately 15-20 minutes, 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. 你的护士会检查你的血压, 温度, 呼吸和脉搏, 并注意是否有副作用. 通常没有副作用, 但偶尔患者可能会感到寒战, 脸红, 恶心和呕吐, 头疼, 血压和呼吸的变化. 移植后的24小时内，您的尿液也可能呈淡红色. However, if your urine remains red after this time or becomes red later, tell your nurse.

新骨髓在移植后不会立即恢复. It takes approximately two weeks for your marrow to start producing white blood cells, 红细胞和血小板.

移植 is the term used to describe when your new marrow begins to function and produce 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 transfusions until you are producing cells again.

You are encouraged to identify and bring with you things from home that will help make your surroundings more comfortable while you are in the hospital. You may bring your own comfortable clothing to wear, such as sleepwear, shorts and T-shirts. 穿自己的衣服会让你感觉不那么像在异国他乡. 衣服穿好后，会交给家人去洗.

出于健康考虑，不允许有鲜花或活的植物. 如果你对带什么进医院有疑问, 你的移植协调员可以和你讨论. 请勿携带刮胡刀、指甲钳等盥洗用品. 这是不允许的. 允许使用电动剃须刀. 如果您戴眼镜，请随身携带. 不要带隐形眼镜，因为你将不被允许佩戴.

你可以带上自己的电脑, 立体声, 视频游戏, 填字游戏, 书籍或其他可以让你在医院里感到舒服的东西.

护士会检查你的生命体征(体温), 脉冲, 呼吸和血压)每隔一段时间测量一次. 在清晨, the nurse also will draw your blood from your catheter and will do your daily weight.

药物和输血不分昼夜. 顾问的访问和测试可以在随叫随到的基础上完成. 你的医生每天至少会来看你一次. If you or your family has questions consult with your inpatient nurse who can contact your coordinator, 医生或其他团队成员迅速处理您的问题. 不要犹豫和你的住院护士谈谈.

在你接受治疗期间, your resistance to infection is low and as a result some there are some foods you cannot eat. 这些包括新鲜水果和蔬菜. 因为这些食物含有大量细菌, 当你的血液计数低时，吃它们是不安全的. 其他食物限制将由营养师向您解释, 谁会告诉你食物的喜好和我们厨房准备的饭菜.

You will need to get out of bed and move around as much as possible to keep your 肺 and muscles in good shape. 除了, walking around your room and the hall as well as sitting in a chair a few times each day can be helpful. However, when you walk around the floor, you must wear a mask and keep your hands clean. 病人 are not allowed to leave the unit unless it is for a medical test or procedure.

在BMT单元的私人房间里, visiting hours are unrestricted and one family member or caretaker may stay with you at night. 必须小心避免将传染病从来访者传染给病人. Children less than 12 years of age and individuals with active symptoms of an infection are not allowed. 一次不允许超过3人参观. 参观者在进入房间时必须洗手.

When your neutrophil count is over 1000, your team will finalize your discharge plans. You will need to be sure that arrangements have been made for someone to stay with you after you are discharged and to be available for clinic visit transportation. 您或您的家人将学习如何护理您的导尿管.

要想出院，你需要:

• 走
• 每天至少摄入所需热量的50%
• 每天至少喝一夸脱液体
• 无活动问题
• 不发烧
• 停用静脉注射药物 & 服用药片
• 能够照顾你的导管

你的移植协调员可以协助安排家庭护理. Your transplant coordinator or your doctor will go over your discharge and outpatient instructions and will review your medications with you.