Pre-transplant preparation

Discussion with patient

Nurses have a key role to play in ensuring that patients are fully aware of the potential advantages, disadvantages, risks and likely side-effects of the transplant process as well as other possible treatment options. Most transplant centres have specialist transplantation nurses who are involved in the initial discussions with patients and their families, and act as a continuous resource during and after transplantation. Having a transplant is not for everyone and is not just about undergoing the procedure – longer term side effects can be difficult to tolerate and have a significant impact on quality of life. These all need to be emphasised to patients.

The whole process, from the initial discussion to recovery after the transplant, can take several months, and for some patients this may seem like a daunting prospect. Engaging in honest but reassuring conversations with myeloma patients about their treatment options is critical. By creating space for dialogue, nurses support informed decision-making, reinforce patient autonomy, and contribute to holistic, person-centered care.

Induction therapy before transplantation

The process of an autologous stem cell transplant begins with induction treatment three to four months prior to stem cell harvest, to eliminate as much of the myeloma disease burden as possible.

In the UK, the most commonly used induction treatments are:

• Daratumumab, bortezomib, thalidomide and dexamethasone (DVTD)
• Bortezomib, thalidomide and dexamethasone (VTD)
• As above but with cyclophosphamide replacing thalidomide in those unable to take thalidomide.

Patients must achieve a good response (partial response or better) in order to progress to the stem cell collection stage of the process.

If a good response is not achieved, patients can be switched to alternative induction treatment. If the second option also fails, alternative options aside from HDT-SCT should be sought. Providing compassionate, individualised support during these moments is an essential component of holistic cancer nursing care.

Induction chemotherapy regimens are covered in more detail in Module 5 – Treatment of myeloma.

Pre-transplant tests and investigations

Before being admitted for their transplant, patients should undergo baseline investigations to ensure their organ function is adequate. These tests are usually performed as an outpatient, and this consultation offers an important opportunity for patients to discuss the procedure in depth with their doctor and nurse so they are fully prepared for their admission.

Pre-transplant investigations include:

• Baseline blood tests – inc FBC, blood group, kidney function, clotting factors, infectious diseases
• Additional imaging tests – Chest X-ray, skeletal survey, CT scan, MRI
• Cardiac function tests – ECG and/or Echocardiogram
• Lung function tests
• Dental assessment
• Psychological assessment