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Evaluating Your Health Before Transplant

The decision to undergo a bone marrow or cord blood transplant (also called a BMT) can be stressful for you and your family. The treatment is hard on your body and can be hard emotionally, too. A transplant doctor will examine you to be sure that a transplant is a good treatment option for you and to better plan your treatment during the transplant process.

Learning about your health

Your health before the transplant can affect how well your body recovers after transplant. Your transplant doctor will do a thorough physical evaluation before you begin your pre-transplant treatment (preparative regimen). This evaluation will reveal some of the risks you may face during and after transplant. It is important that you understand these risks before deciding to have a transplant.

Your transplant doctor will review your health history, do a physical exam and order tests to:

Check your body's overall health, including organs such as heart, lungs, liver and kidneys
Check for problems, such as an infection, that should be treated before transplant
Evaluate the status of your disease — for example, is it active or in remission?
Find out how your disease responded to previous treatments
Look for any other health problems that might affect your transplant

Physical exam and tests

Pre-transplant exams vary from hospital to hospital. Most likely the doctor will look at your:

Heart, to find any problems that might get worse after transplant — the heart tests often used are an electrocardiogram (EKG) — which shows heart rhythms, and an echocardiogram or a multiple gated acquisition scan (MUGA scan) — which measure how well your heart is pumping.
Mouth and teeth, because post-transplant infections are common here.
Liver, because some pre-transplant drugs can affect the function of the liver.
Lungs, because pre-transplant drugs and radiation may damage the lungs. Your doctor will look for lung damage caused by previous chemotherapy and/or radiation therapy.
Kidneys, because some post-transplant drugs may affect the function of the kidneys.
Disease status — If you are being treated for a blood-related cancer, a bone marrow biopsy and/or bone marrow aspiration will be done to confirm your disease is in remission. If you are being treated for lymphoma, you may have a positron emission tomography (PET) scan or gallium scan to find out how active your disease is.

For patients with some diseases, doctors also check the brain and spinal fluid. Patients with leukemia or lymphoma may have a test called a lumbar puncture (or spinal tap). For this test, a needle is used to collect some of the fluid around your spinal cord. If any disease cells are found in this fluid, the disease will need to be treated before your transplant.

Health history review

Your doctor will also review your health history by asking you questions about your health. With a good understanding of your health history, your doctor can better decide whether a transplant is a good option for you. Your doctor will also be better prepared to treat or prevent problems.

Infection history

Your doctor needs to know about any infections you have had. Infections can be life-threatening after a transplant, when your immune system will be weak. One infection that can be especially dangerous is called aspergillus. Aspergillus is a common fungus found in the soil and in the air. If you have had aspergillus or a similar infection, your doctor will want to make sure that infection is completely gone. Some infections can also return easily after transplant. If your doctor knows you have had these infections, you can be treated to try to prevent their return.

Previous treatments

Many patients planning to undergo a bone marrow or cord blood transplant have been treated with chemotherapy and/or radiation therapy. These treatments can damage organs such as liver or kidneys. The treatment you receive to prepare for transplant (preparative regimen) may add to this organ damage. Your transplant doctor will need to know the kind and amount of any treatment you received. He or she may adjust your preparative regimen based on the treatment you had earlier.

Emotional and care concerns

Your doctor needs to know if you will be able to handle the stress and demands of your transplant. If you have a mental health issue, your doctor will see whether your mental health or any medications you need could interfere with your transplant treatment. If you have signs of alcohol or drug abuse, you may not be healthy enough for a transplant. You may also need to be evaluated by a mental health professional before deciding to go forward with a transplant.

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. Most transplant centers require you to have a caregiver. Your caregiver will help you in the hospital and take care of you when you go home. To learn more, see What to Think about When Selecting a Caregiver.

Screening potential donors and cord blood units

People who want to be volunteer marrow or blood cell donors through the National Marrow Donor Program (NMDP) are also given health evaluations. This is done to make sure they are healthy and the cells they donate are as safe as possible for a patient. To learn more about how the NMDP screens donors and cord blood units, see NMDP Guidelines to Safeguard Patients.