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

The chemotherapy and radiation that you receive immediately prior to your transplant have the potential to seroiusly damage the heart, lungs, liver and kidneys. Tests are done before transplant to determine your risk for damage to these organs. It is important that you understand these risks before deciding to have a transplant.

Physical exam and tests

Pre-transplant exams vary from hospital to hospital. Listed below are tests that your doctor might order before transplant. Not all tests are performed on all patients. You may also have additional tests, depending on your diagnosis and health history.

• Echocardiogram (ECHO)/MUGA/Electrocardiogram (ECG): Tests to determine the heart's ability to circulate blood through the body. 
• Dental exam: The mouth and teeth are a potential source of infection during transplant. You must be examined by a dentist and have any necessary dental work completed. 
• Blood tests: Blood tests are done to evaluate the liver and kidneys and check for any infectious diseases.
• Pulmonary function tests (PFTs): PFTs determine how efficiently air is moved in and out of your lungs and how well the lungs are delivering oxygen to the bloodstream. 
• Bone marrow aspiration and biopsy: 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.
• Positron emission tomograph (PET) scan: PET is a highly specialized X-ray that uses short-acting radioactive substances to produce powerful images of the body's internal organs. PET distinguishes cancer cells from healthy cells.
• Lumbar puncture or spinal tap: During a lumbar puncture, fluid from the spinal canal is removed and sent for tests to look for signs of cancer. If any diseased 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 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.

Mental health 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. Many 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.