At Lurie Children’s, the day that a stem cell transplant is performed is known as “Day Zero.” Negative (or minus) numbers are assigned to the days leading up to the procedure. After a transplant is performed, the count forward begins with many milestones of recovery occurring within the first 100 days.
While the stem cell transplant team tries to standardize guidelines and recommendations for patients, each family’s journey through transplant is unique. The timeline is intended to serve as a framework for understanding the transplant process, while realizing that each patient’s progress is individualized and may vary depending upon the original diagnosis, the child's response to chemotherapy and various medications, and complications that may occur throughout the transplant period.
Transplant Timeline Leading to "Day 0" (Transplant Day)
Diagnosis: Diagnosis of malignant cancer, immuno-deficiency disease or blood disease
Physicians consider the type of disease, its stage of progression, and the age and general health of the child prior to recommending a hematopoietic progenitor cell transplant
Progenitor stem cells may also be called:
Day -180 to -30: Transplant conference/donor selection
The patient and family come for their pre-transplant conference to discuss whether a transplant would benefit them and which type would be most beneficial. A child who requires an allogeneic donor source must have their tissue type identified and matched with a suitable donor. Siblings are the most likely related donors. If no donor source is found in the immediate family, a search is conducted with a national registry.
Day -30 to -1: Chemotherapy and/or radiation (if required) and admission to the hospital (if required)
Chemotherapy and/or radiation are given to eradicate the disease and to eliminate the patient’s own immune system so it won’t fight the new cells. If a child needs to be admitted to the hospital for the transplant, it occurs during this time frame. They would then be placed in a transplant room for isolation at Day -1.
Day 0: Day of Transplant
The child receives the new stem cells as an infusion through the central venous access catheter. The child is pre-medicated with specific medications to help their body accept the cells.
Day + 1 to +30: Protective isolation
Since the child’s immune system has been depleted by chemotherapy, they are extremely vulnerable to infection. To avoid infections, strict protective isolations must be observed. Depending upon the preparative chemotherapy and/or radiation used, this may include being confined as an inpatient to a transplant room and having limited contact with visitors.
Day +10 to +32: Engraftment
Caregivers and the stem cell transplant team watch for signs that the new cells have found their way into the patient’s bone marrow and are starting to produce new blood cells. They also watch for complications associated with engraftment.
Day +15 to +30: Discharge from hospital
If a patient has been hospitalized for transplant, discharge often occurs during this time frame. The patient is a candidate for discharge once the white blood cell count shows they are beginning to regain the ability to fight infection. Normally a patient would transition to Kohl's House for several weeks before going home.
Day +30 to +100: Home care and outpatient management
Still vulnerable to infection, isolation precautions must continue to be observed, whether the patient is at Kohl' House or their own home. The child returns to the ASCU once to several times a week, so the doctors and nurses can monitor their progress, blood counts, engraftment status, vital signs, and any complications.