自体移植

骨髓移植医生将通过回顾您的医疗记录和病史来开始评估, 进行身体检查, 然后和你讨论一下手术过程. 这次访问将是您的第一次咨询，还将包括骨髓移植协调员, 谁会在整个过程中帮助你. If it is determined that you are a candidate for an autologous stem cell transplant, 治疗方案将会确定.

在被送进医院之前, 你将有几天的实验室和其他诊断测试来确定你的心脏功能是否正常, 肺, kidney and liver and that you do not have an undiagnosed infection. 在你入院之前，这些检查大部分都是作为门诊病人进行的. 这些测试可能包括:

• 血液测试
• Urine test and/or 24 hour urine collection
• 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

Having vascular access enables the health team to administer chemotherapy, 其他药物, blood products and even the stem cell transplant to you painlessly. 也, 该导管将用于提取治疗过程中所需的血液检测样本, thereby minimizing the need to insert needles into your arms or hands. 在一般情况下, the catheter is present throughout the hospital stay, and will be removed once you no longer need it and your counts have recovered.

干细胞主要存在于骨髓中，但也可以通过刺激进入血液. 当通过多次骨髓移植从髋骨中收集干细胞时, which are usually performed in the operating room, the transplant procedure is called a bone marrow transplant. 当用一种叫做G-CSF的激素刺激干细胞后，从血液中收集干细胞, the transplant is called a peripheral blood stem cell transplant. 目前，大多数移植手术包括从外周血中收集干细胞. When bone marrow or blood stem cells are infused into the recipient, 它们通过静脉导管或中心静脉导管进行管理，就像输血一样. The stem cells are not administered directly back into the bone, but travel to the bones from the blood stream.

• 外周血干细胞收集

从骨髓中收集干细胞是医院手术室的一项外科手术, 通常在全身麻醉下. It involves little risk and minimal discomfort. 在麻醉状态下, a needle is inserted into the cavity of the rear hip bone called the iliac crest, where a large quantity of bone marrow is located. The bone marrow is a thick, red liquid which is extracted with a needle and syringe. 通常需要在每条髋关节上穿刺一到两次，并在骨头上多次穿刺以提取骨髓. 它不需要手术切口或缝线，只需要在针头插入的地方刺穿皮肤.

You will be admitted to the hospital on the day your chemotherapy begins. Your admission date may be changed based on bed availability. The length of your admission will be between two to four weeks.

Chemotherapy begins soon after you are admitted to the hospital. Your doctor will discuss all of the drugs you will receive and their side effects. 您的移植协调员和住院护士将会回答您的问题. 此外，您将在同意书中收到有关这些药物的书面信息.

Precautions are taken to minimize side effects from these drugs.

Some patients receive total body irradiation (TBI) in addition to chemotherapy. 这种放射疗法旨在摧毁残留的癌细胞，进一步抑制免疫系统. 创伤性脑损伤的治疗通常在放射治疗部门进行，时间通常为三到四天. 治疗本身是无痛的, but there may be uncomfortable side effects after treatment, 比如口腔和咽喉溃疡, 恶心想吐, 肠胃不适, 皮肤发红. Anti恶心想吐 medication is usually given before each treatment to reduce 恶心想吐.

移植细胞或干细胞将在最后一次化疗或放射剂量后一到两天内注入. The day of transplantation is referred to as Day 0. 移植前的天数为负天数，移植后的天数为正天数.

移植手术类似于简单的输血，将在你的病房里进行. You may have a family member in the room with you if you wish. 实际的过程大约需要15-20分钟，取决于干细胞的体积. 血液干细胞将通过你的中心静脉导管输入就像常规输血一样. Your nurse will check your blood pressure, 温度, 呼吸和脉搏, 并注意是否有副作用. 通常没有副作用, but occasional patients may experience chills, 脸红, 恶心和呕吐, 头疼, and changes in blood pressure and breathing. Your urine also may be tinged red for the first 24 hours after transplantation. 然而，如果你的尿液在这段时间后仍然是红色的，或者之后变得红色，告诉你的护士.

The new bone marrow does not recover immediately after it has been transplanted. 你的骨髓大约需要两周的时间才能开始产生白细胞, 红细胞和血小板.

移植 这个术语是用来描述你的新骨髓何时开始发挥作用并产生细胞吗. 在等待移植的过程中，没有成熟细胞离开骨髓进入血液. 你的血球计数将显示非常低的数值，你将需要由健康护理小组仔细监测. 目的是通过红细胞和血小板输注来支持你，直到你再次产生细胞.

我们鼓励你从家里找出并带一些东西，这些东西会让你在医院里的环境更舒适. 你可以自己带舒适的衣服，比如睡衣、短裤和t恤. Using your own clothing will make it feel less like a foreign environment. After it has been worn, clothing will be given to a family member to launder.

For health reasons, no fresh flowers or live plants are allowed. If you have questions about what is appropriate to bring into the hospital, your transplant coordinator can discuss it with you. Please do not bring toilet items such as: razors and nail clippers. 这是不允许的. 允许使用电动剃须刀. If you wear eye glasses, please bring them. Do not bring contact lenses as you will not be allowed to wear them.

你可以带上自己的电脑, 立体声, 视频游戏, 填字游戏, books or anything else that may keep you comfortable while you are in the hospital.

A nurse will check your vital signs (温度, 脉冲, respiration and blood pressure) at intervals around the clock. 在清晨, the nurse also will draw your blood from your catheter and will do your daily weight.

Medications and transfusions are given throughout the day and night. Consultants' visits and tests may be done on an on-call basis. Your doctors will visit you at least once a day. 如果您或您的家人有疑问，请咨询您的住院护士，她可以联系您的协调员, physician or other member of the team to take care of your question quickly. Do not hesitate to talk with your inpatient nurse.

在你接受治疗期间, 你对感染的抵抗力很低，因此有些食物你不能吃. These include fresh fruits and vegetables. Because these foods have a high bacteria count, they are not safe to eat while your blood counts are low. Other food restrictions will be explained to you by the dietician, who will talk to you about food preferences and meals prepared in our kitchen.

你需要从床上爬起来，尽可能多地活动活动，以保持肺部和肌肉的良好状态. 除了, 每天在你的房间和大厅里走几圈，坐在椅子上也会有帮助. 然而，当你在地板上走动时，你必须戴上口罩并保持双手清洁. 病人不得离开病房，除非是为了进行医学检查或手术.

在BMT单元的私人房间里, 探访时间不受限制，夜间可以有一名家庭成员或看护人陪伴您. 必须小心避免将传染病从来访者传染给病人. 12岁以下儿童和有感染症状的人不允许进入. No more than three visitors are allowed at a time. 游客 are required to wash their hands upon entering the room.

当你的中性粒细胞计数超过1000时，你的团队将确定你的出院计划. 你需要确保在你出院后有人陪在你身边，并且有接送你去诊所的交通工具. You or a family member will learn how to care for your catheter.

要想出院，你需要:

• 走
• Eating at least 50% of required calories a daily
• Drinking at least one quart of fluid daily
• 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

Your transplant coordinator can assist with arrangements for home care. 你的移植协调员或你的医生会检查你的出院和门诊指示，并和你一起检查你的药物.