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Evaluating Your Health Before Transplant

Before you decide to have a marrow or blood cell transplant, it is important to know what risks you might face. A transplant can be very hard on your body. Your health before the transplant can affect how well your body is able to recover. A transplant doctor will examine you carefully before deciding that a transplant is a good treatment option for you.

The transplant doctor will examine you to:

• See if your body is strong enough for a transplant
• Look for any special risks you might face
• Find out more about your disease
• Look for problems, such as an infection, that should be treated before your transplant

The exam helps you and your doctor better understand the challenges you may face during a marrow or blood cell transplant.

Checking Your Overall Health

Your doctor will check your overall health by looking at the following areas.

1. Mouth and Teeth
   After transplant, your mouth is an area where infections can start easily. A dental X-ray and exam can spot problems that might lead to a chance of infections. If you need any dental work, it is usually done before your transplant.
   
   
2. Lungs
   The chemotherapy and/or radiation therapy used to prepare you for transplant can damage the lungs. Serious complications after transplant can also involve the lungs. Because of these possibilities, your doctor will do tests to see how well your lungs work.
   
   
3. Heart
   Your doctor will test how well your heart is working. The tests will show any problems with your heart that might grow worse after transplant.



4. Liver
   Your liver will be tested for signs that you might be at risk for a liver disease called veno-occlusive disease (VOD). VOD can be caused by the treatment you receive to prepare you for transplant. VOD is sometimes very serious.



5. Kidneys
   Tests will check that your kidneys work as they should. Many drugs given to patients after transplant can be hard on the kidneys. The less damage the kidneys show before transplant, the better.



6. Brain and Spinal Cord
   You will be tested for any disorders of the brain and spinal cord (or central nervous system). If you have leukemia or lymphoma, you will have a spinal tap. A spinal tap uses a needle to draw out some of the fluid around your spinal cord. If any signs of disease are found in this fluid, the disease must be treated before transplant. Some diseases of the brain and spinal cord may make a transplant too risky to be a good treatment option.

Evaluating Your Disease

To plan the best treatment for you, your doctor needs to know more about your disease. The tests your doctor will do depend on your disease. Some of the things your doctor may check include:

• How strong (or aggressive) your disease is
• How quickly your disease is getting worse
• How much of your body is affected by your disease
• Whether your disease is in remission (for leukemia and other cancers)
• How well the disease responded to other treatments

This information is important in planning a schedule for your transplant. Your doctor might learn that more treatment is needed before transplant. This information can also help the doctor plan the kind of treatment you receive to prepare for transplant.

Reviewing Your Health History

Your doctor will review your health history. With a good understanding of your health history, your doctor can better recommend whether receiving a transplant is a good option for you. Your doctor is also better prepared to treat or prevent any problems that might arise.

History of Infections

Your doctor needs to know about any infections you have had. A healthy immune system fights infections. But your immune system will be very weak after your transplant. Infections at that time can be life-threatening. One infection that can be especially dangerous is called aspergillus. Aspergillus is caused by a common mold found in soil and plant debris as well as in the air inside some buildings. If you have had aspergillus or similar infections, your doctor will want to make sure they are completely gone. In addition, some infections can return easily after transplant. If your doctor knows you have had these infections, you can be treated to prevent their return.

Previous Chemotherapy and/or Radiation Therapy

Many patients who are considering a marrow or blood cell transplant have been treated with chemotherapy and/or radiation therapy. The transplant doctor needs to know the kind and amount of treatment you received. Over time, the effects of treatment build up and can result in a greater risk of organ damage. Therapy you get to prepare for transplant adds to this risk. Your doctor may adjust your pre-transplant treatment based on the treatment you have had before.

Mental and Social Evaluation

Your doctor needs to know that you will be able to handle the stress and demands of the transplant process. If you have a mental disorder, your doctor will need to follow up to see whether your disorder or the medications you need could conflict with your transplant treatment. Any history of drug or alcohol abuse will need to be considered.

Your doctor also wants to be sure you have someone to give you emotional support and help take care of you during and after your transplant. Many doctors require you to have a caregiver. Your caregiver will help you in the hospital and take care of you when you leave. Having a good caregiver and social support system can make a big difference in your recovery.

Transfusion History

Your doctor can get valuable information from your experience with blood and platelet transfusions. Knowing how you react to red blood cell and platelet transfusions can help your doctor during post-transplant care, especially if you have had bad reactions. For patients with aplastic anemia, having a lot of transfusions before transplant can increase the likelihood the transplant will fail.

Conclusion

Doctors continue to find new ways to make transplants safer for patients. With newer approaches, patients who are older or have more health problems are now able to have transplants with good outcomes. Still, it is important that you understand your risks before deciding to have a transplant. The pre-transplant health exam helps both you and your doctor better understand whether a transplant is a good treatment option for you. The exam will reveal some of the risks you may face. You and your doctor may decide that a transplant is not the right treatment for you. Or you may decide that a transplant is the best choice. Either way, the exam gives you and your doctor more complete information to help you make your decision.