Medical appointments and planning ahead

Pre-treatment appointments

The conditioning therapy and the transplant itself are big tasks for your body.

They will probably cause some short and long-term side effects that could be difficult to cope with. This means it’s important to check you're otherwise in good health before treatment can go ahead.

You'll have the chance to discuss all possible side effects with your consultant and transplant team before consenting to treatment. During these appointments, the following tests are likely to be performed: 

• A bone marrow biopsy or CT-PET scan, or both, to confirm that you're in remission.
• Electrocardiogram (ECG) to check the rhythm and electrical activity of your heart.
• Echocardiogram (ECHO) to look at the heart and nearby blood vessels.
• Lung function tests to measure how much air your lungs can hold.
• Blood tests to check how many blood cells are present and to test your liver function.
• A blood test, known as an EDTA test, to assess how well your kidneys are working.

Central venous catheter (CVC)

You will need lots of medication and supportive therapies before, during and after your transplant. This is as well as other treatments such as your chemotherapy. To make this as simple as possible, you'll be fitted with a CVC (sometimes called a Hickman line) soon before your chemotherapy is due to start.

The CVC is a thin tube that goes through the skin near your collarbone and into the big vein that leads into your heart. Or you may have a peripherally inserted central catheter (PICC) line in your upper arm. Both lines let the nurses and doctors take blood samples and deliver treatments and the stem cells themselves without using a needle every time.

You’ll need to keep an eye on your CVC to avoid it getting pulled out of place. It’s also important to try to keep the dressing dry.

Your CVC is usually in for a few months. As it can create a risk of infection after your transplant, it will be removed as soon as it’s no longer needed. Usually, you'll go to the outpatient clinic for removal of your CVC. This needs a local anaesthetic. You may need a stitch or two to help the wound heal. Many people see its removal as a positive step in their recovery.

Dentist

It’s important to have a dental check-up, even if you're not worried about your teeth.

Do you know of any work that needs doing? Get it done before starting treatment because there'll be a risk of infection once it begins. Your hospital team will usually organise this for you.

General health and fitness

Nutrition and exercise are both very important when preparing for your transplant. If you can eat well and exercise during this time, you'll be in the best place to start your recovery. And though you might feel quite unwell now, a few small changes could have a huge benefit.

Diet – if you struggle to eat enough calories and maintain a healthy weight, it can start to affect your general health. Simple things, like eating little and often or adding ingredients with lots of protein and calories to your food, could make a big difference.

Exercise – it doesn’t have to be anything strenuous. For example, gentle exercise such as walking, swimming or cycling can improve your stamina and strength. Exercises like yoga can strengthen muscles, make you more flexible, and help you relax. This could also be good for your mental health.

Your transplant team or GP will be able to give you more specific advice and suggest some things to try that are tailored to your specific situation.  

Hair loss

Most people will lose their hair after chemotherapy treatment, which can be very distressing. But take heart – it will usually grow back within a few months. For more information see the Macmillan Cancer Support page – Hair loss during treatment.

Practically speaking, you'll need to cover your scalp with a hat or scarf to avoid:

• losing heat in the winter
• getting sunburned in the summer.

If you’d prefer to wear a wig, your hospital should have a scheme in place to provide you with one for free.

Some people decide to experiment with hairstyles they’ve not dared try before. If you have long hair, you may want to try out some shorter styles before treatment starts.

Macmillan Cancer Support has a useful booklet, Coping with hair loss.

Look Good, Feel Better runs free workshops offering advice on skincare, grooming and make up to women and men undergoing cancer treatment.

The Little Princess Trust provides free wigs for young people who have lost their hair following treatment.