Outpatient Transplant

On this Page:

• What to Expect
• Pre-transplant conditioning therapy
• Stem Cell Infusion
• After Stem Cell Infusion
• FAQ

What to Expect

Outpatient stem cell transplants are just as safe and effective as inpatient transplants. The care you will receive is the same for both settings. The primary difference is the location. 

To be considered for outpatient transplant, the following criteria must be met:

• Treatment plan: Outpatient transplant is suitable for certain treatment plans. Your physician will discuss whether this option is appropriate for you.
• Full-time caregiver: A dedicated caregiver is essential to provide full-time support throughout the 14- to-21-day transplant period. The caregiver plays a crucial role in monitoring symptoms and transporting you to and from the clinic.
• Nearby lodging: You must reside within a specific distance from Dana-Farber during the outpatient transplant period. This could be at your home if close by, or in nearby short-term housing accommodations. Our resource specialists are available to help identify suitable housing options if needed.

Preparing for Outpatient Transplant

During outpatient transplant, all aspects of care – including conditioning chemotherapy, stem cell infusion, engraftment, and follow-up monitoring – take place at the outpatient clinic at Dana-Farber’s Yawkey Center for Cancer Care, rather than in the hospital. This process usually spans 14 to 21 days, during which you will visit the clinic daily and return home or stay at a nearby hotel.  

This includes daily visits for:

• Conditioning chemotherapy
• Infusions of fluids, blood products, and supportive care if needed prior to your stem cell infusion
• Stem cell infusion
• Scheduled clinic visits, usually for 10-21 days after your stem cell infusion. You should plan to be in the clinic every day, though some visits may not be needed depending on how you are feeling.
• Scheduled education sessions about how to care for yourself during and after the outpatient transplant period.

Each day, you will visit the clinic to receive treatment, participate in educational sessions with the care team, and meet with your clinical team. Your clinic visits may be lengthy, and you will likely be in the clinic for up to 12 hours each day. 

Note

Depending on your symptoms and side effects during the transplant period, you may need to be admitted to the hospital for additional treatment or monitoring.

• If this is needed, you will be admitted to Brigham and Women’s Hospital (BWH) or the Dana-Farber Inpatient Hospital located within BWH.
• Your care will transfer back to the outpatient clinic when your condition stabilizes.
• If you are admitted to the hospital, the inpatient care team’s guidelines and restrictions may differ from what is outlined here. Talk with your care team if you have questions.

Reminders for Your Clinic Visits

• Wear a mask to protect yourself from infection when outside of your room.
• Bring your Outpatient Transplant Workbook (which will be given to you during your consent appointment) and your medications, if instructed by your care team.
• Bring requests for medication refills before your medication runs out.
• Wear layers of comfortable clothing.
• Pack things to help pass the time, such as a book, tablet device, or laptop.
• Drink plenty of fluids.
• Bring snacks and drinks that follow our nutrition guidelines. Some food will be provided for you in the clinic.
• Limit visitors to 2 per day to allow for infusions, education, and rest.
• For Allogeneic Patients ONLY: Do NOT take your morning dose of Prograf (tacrolimus) and Rapamune (sirolimus, rapamycin). Bring these medications with you to take after your blood has been drawn.

Pre-Transplant Conditioning Therapy

To prepare for your stem cell transplant, you will receive conditioning chemotherapy (or pre-transplant therapy) to prepare your body to receive the new blood stem cells.

Chemotherapy

Chemotherapy prior to transplant can kill cancer cells in your body, but also helps make space for your stem cells to grow and can help your immune response fight your cancer. Your stem cell transplant pharmacist will review your chemotherapy medications with you during your medication teaching session.

Chemotherapy consists of either one drug or a combination of drugs. It is usually given in a vein or through a central venous catheter. Chemotherapy can have many side effects including:

• Bone marrow suppression (decreased red and white blood cells and platelets)
• Hair loss
• Nausea and vomiting
• Diarrhea
• Dry mouth
• Sore throat
• Mouth sores
• Taste changes
• Sterility and/or interruption of the menstrual cycle
• Fatigue (feeling tired/lack of energy)
• Loss of appetite

Your care team will review these with you and can give you medications to help manage and treat some of these side effects.

During Stem Cell Infusion

You will receive your stem cell infusion on Day 0. Stem cell infusion is a similar process to a blood transfusion. Many patients talk about how surprised they are at how fast and uneventful the stem cell infusion is. The stem cells come in the same bag that blood comes in and can appear clear, yellow, or pink in color.

• Depending on if you are having any symptoms on Day 0 you might receive intravenous (IV) hydration and/or anti-nausea medication.
• Depending on what type of central line you have, we may need to insert a peripheral IV to infuse your stem cells.
• Shortly before the infusion your nurse will give you medications to prevent a possible reaction.
• Prior to starting the infusion, your nurse and a second nurse will come into your room and verify the stem cells are for you.
• Chaplaincy can bless your cells prior to the infusion, if that is something you are interested in.
• Your nurse will then check your vital signs and begin the infusion. Your vital signs will be checked again 5 minutes into the infusion and at the completion of the infusion. You will remain connected to the vital signs machine during the entire infusion.

A typical peripheral stem cell infusion can take anywhere from 20 minutes to an hour depending on the volume of the product and if you experience any side effects. There may be multiple bags of stem cells to be infused. With multiple bags of stem cells, the infusion will take more time.  

Although the bags may look small, the volume of fluid is not important, it is the number of stem cells you are receiving that is important. A small amount of fluid can have millions of stem cells!

Side Effects

Potential side effects that you should let your nurse know about include:

• Full body flushing/facial flushing, itching, hives
• Trouble breathing, shortness of breath, coughing, chest pain/tightness
• Abdominal cramps, nausea/vomiting
• Light headedness

Your nurse will be with you during the whole stem cell infusion. You will not be alone.

Additional Side Effects from DMSO (Dimethyl Sulfoxide)

DMSO (Dimethyl Sulfoxide) preservative is used to protect your stem cells if they are frozen. DMSO can cause some side effects during and after your infusion. Common side effects are hives, nausea, vomiting, stomach cramping, diarrhea, facial flushing, high or low blood pressure, fast or slow heartbeat, chest tightness, fever, and chills. Tell your care team how you are feeling. They are experienced in managing these side effects.  

Your body’s expected response to the DMSO can include:  

• A strong unpleasant taste in your mouth. Sucking on hard candy can help.  
• You and others around you may notice an odor during the infusion and in your body fluids (urine, sweat) over the next 1 to 2 days. Some describe it as a garlic-like odor.
• Your urine may change color (pink, red or orange). This is a result of your body removing the red blood cells that were mixed in with your stem cells. The discoloration can last for 24 to 48 hours after your stem cell infusion.  

After Stem Cell Infusion

There is a chance that you may experience a delayed infusion reaction. For this reason, you must remain in the clinic for observation for 2 hours following the completion of your infusion. Your nurse will not remain in the room with you during this monitoring period but will be checking on you frequently, be available if you have any questions, or if you need anything. In the days after your stem cell infusion, you may have one or more of these side effects:

• Fever
• Nausea
• Fatigue
• Difficulty sleeping
• Skin rashes
• Mucositis, which are mouth sores and can make it difficult to eat or drink
• Diarrhea which may persist for some time
• Lack of appetite. Many patients do not eat very much for several days after their stem cell infusion. This is common, so be sure to eat when you can and drink plenty of fluids.

Scheduled Clinic Visits After Your Stem Cell Infusion

Following your stem cell infusion, you will have appointments every day for 10 to 21 days. Your care team will test your blood counts every day to check for engraftment. Engraftment is when your new stem cells begin to make new blood (red blood cells, platelets, and other parts of the immune system). The time it takes to reach this stage depends on many factors, including stem cell source (bone marrow or peripheral blood), the type of transplant, and your pre-transplant therapies.  

Your clinic visits may be lengthy. You should plan to be at the clinic for up to 12 hours each day. During your scheduled visits, you will:

• Meet with your care team, including your outpatient transplant doctor, NP/PA, and nurses.
• Have blood draws/labs to check your blood counts. Based on your counts and how you feel, you may get infusions of fluid, blood, or support drugs such as anti-nausea medicines.
• Receive medications as part of your treatment plan, or supportive care.
• Review your medications and medication sheets.
• Have education sessions to review diet, medication, and infection precautions.

You may also see a pharmacist, dietitian, social worker, or resource specialist when needed.

Your caregiver will need to bring you to and take you home from your appointments. They will also need to participate in the education sessions with your care team. It is not necessary for them to stay with you the entire time. There will be times when they can get out to take a walk or get a coffee.

Is the treatment different for inpatient and outpatient transplant?

Not really. The treatment approaches for stem cell transplant in the outpatient and inpatient settings are quite similar. Certain treatment approaches (i.e., conditioning regimens) can be administered in the outpatient or inpatient setting. You will receive the same treatment as an outpatient as you would have received if you were admitted to the hospital for the entire duration of your transplant. The only difference is where you receive your care.

Is outpatient transplant as safe and effective as inpatient transplant?

Yes, outpatient transplant is as safe and effective as inpatient transplant.  

Can I have visitors to my home/hotel?

You may have a small number of visitors. All visitors must feel well and be free of any illness. You and the visitors must wear a mask to protect you from infection while your immune system recovers. You and your visitors should also practice good hand hygiene by washing your hands often.

What should I do if my caregiver gets sick and cannot care for me?

Because your immune system is weakened during your transplant treatment, no one who is ill or not feeling well should come into contact with you. If your caregiver is ill, another caregiver should take on the caregiver responsibilities until your primary caregiver is well again. If you are not able to identify an alternate caregiver, tell your care team right away.

If I need to be admitted to the hospital, can my caregiver stay with me?

No visitors, including your caregiver, may stay overnight with you if you are admitted to the hospital.

When do I need to wear a mask?

Wear a mask during all clinic visits to Dana-Farber unless you are in your private room. You should also wear them in all public places, and if you are near someone who has been ill.

You do NOT need to wear a mask in your home or car, or when you are outdoors (unless you are in a crowd). You should wear a mask when in public places. Wash your hands frequently.

Where can I go during the outpatient transplant period?

We encourage you to go outside, take walks, and exercise. However, be careful, because infection is a major concern. Check the “After Transplant” section of your education binder. Always wear a mask when you are in public places.

Can my pet stay at home with me?

Generally, pets are allowed in your home, as long as you are not grooming or feeding the pet, or changing a cat’s litter box yourself. Your pet should not sleep on your bed. Recommendations on specific types of animals are in the After Transplant section of your education binder. Discuss any concerns or specific pet care questions with your care team.