Bone marrow transplants (BMT) are a cornerstone of hematologic cancer treatment.  However, the thought of BMT often scares PTs out of our minds.

Especially for us in outpatient cancer rehab, we may think that we won’t encounter these patients.

But here’s the truth: we WILL see these patients.  My first experience was a complete surprise: my patient came to see me in outpatient physical therapy AFTER their bone marrow transplant.  So I was totally unprepared!

All this say: we MUST be prepared to treat patients who undergo BMT.  Thankfully, Dr. Adam Matichak, PT is an expert in all things BMT.

In today’s interview, we chat about the basics of BMT, what every OncoPT needs to know about BMT, & how we can navigate care with this highly dynamic group of patients.

What is BMT?  

A bone marrow transplant (also called hematopoietic stem cell transplant) is a method to treat hematological cancer.  These patients have dysfunctional bone marrow, & these abnormal cancer cells crowd out normally functioning cells.  

A patient may undergo an autologous (their own stem cells) or an allogeneic (someone else’s stem cells) bone marrow transplant.  These stem cells will be harvested from the person (or donor) & then processed & grown in a lab.  

Patients will then undergo chemotherapy prior to the BMT, which wipes out their immune system (as a way to “reset” their immune system & to not reject the stem cells).  At this point, the patient will have either their own cells or someone else’s stem cells infused into their body.  And hopefully, this cures their cancer.

Ideally, patients will be cured by their BMT.  While this is possible, one of the biggest milestones is to live 5 years after transplant.

Even though not every patient will be cured by BMT, the additional time patients can spend with the people they love, doing the things they love is an enormous benefit of BMT.

Who gets a BMT?

Patients with:

• Leukemia
• Lymphoma, especially Non-Hodgkin Lymphoma
• Multiple myeloma
• Myelofibrosis
• Severe aplastic anemia
• Patients at high risk of relapse

Patients are first evaluated to see if they are a candidate for BMT: Does the patient have stable disease? Are they responding to treatment? Would BMT do more harm than good?

Not every patient will be a candidate for BMT, but cancer rehab can actually help patients become better BMT candidates!

What should the physical therapist know about BMTs?

In the perfect situation, the patient will undergo their BMT with no complications & be cured of their cancer.  The reality is quite a bit more nuanced.

Patients can have significant complications & side effects as a result of BMT.  

Some common side effects include:

• Anemia
• Thrombocytopenia
• GI: mucositis, for example
• Pain
• Cancer-related fatigue
• Neuropathy
• Weakness/deconditioning

Need a review on safety with anemia & thrombocytopenia?  Check out A Focused Review of Safety Considerations in Cancer Rehab with Dr. Susan Maltser. 

Patients who undergo an allogeneic BMT may also experience graft-versus-host-disease, which is an immune system reaction to the donor’s stem cells.  This can affect multiple body systems, & can be acute, chronic, or even both for some patients. 

More from Ep. 204

How do we navigate death & dying in OncoPT? How do we not get lost amongst all the potential impairments these patients can face?

Tune into Ep. 204 for the full scoop on BMT with expert Dr. Adam Matichak, PT. You can also follow him on Twitter.

So now I want to hear from you: what did I miss? What else would you include in this episode about bone marrow transplants? Message me on Instagram and let me know.

Until next time, this is Elise with TheOncoPT.

And remember:

YOU are exactly the physical therapist that your patients with cancer need.

So let’s get to work.

Be the Match – sign up to be a donor.

You could save the life of a person with cancer. Donors are needed. You are needed. Sign up for the Bone Marrow Registry today.