Transplant Procedures: High Dosage Radiation/Chemotherapy

Your radiation or chemotherapy will very likely begin during the evening of your first day in the hospital.  The regime used will depend upon your disease.  My lymphoma required eight days of chemo, with three different mixes administered multiple times a day, while Carlos’ myeloma only required two days of chemo.  Usually these meds will be administered by IV via your Aphaeresis line (drip and/or syringe push).  If any of your chemo meds are given orally, make a note of it.


Radiation treatment is administered in much the same way, with certain dosages given multiple times a day, although radiation is not delivered by an IV, but instead by irradiation equipment.  Your transplant doctor will be able to tell you your treatment schedule long before the in-patient procedure begins.



During most of your time in the hospital you will be connected to an IV through your Aphaeresis line.  Sometimes this will be used for delivering meds, but a bulk of the time you’ll simply be receiving hydrating fluids like a saline solution.  The line is left in place in case emergency delivery of meds is required.  Being constantly connected to your IV stand is a pain for showering and going to the bathroom, though, since you’ll have to drag the IV set-up along with you.  Talk to the nurse about being unhooked for part of each day to make these tasks easier for you.



Since the dosage levels of the radiation or chemo administered are so high, you may experience multiple after-effects.  Even if you’ve had the treatment before with few or no side-effects, the dosage for a transplant may result in a significantly different experience.  With one exception (hair loss), I’m going to cover the topic of after-effects later in this page.



Hair loss: Not everyone loses their hair during the normal administration of radiation or chemo.  The dosage used for a transplant, however, is so high that you can pretty much be assured that you will lose it now.  This also happened to me during my first round of non-transplant chemo and I quickly learned that having my hair come out in patches – usually onto my pillow and bed – was worse than losing it in one fell swoop.  I had the nurse on my floor shave my head shortly after check-in to avoid this mess.  If you do this, bring along some caps in case your head gets cold.



By the way, it took longer for my hair to come back in after the transplant – almost four months – than it did during my first chemo treatment.  The first time I lost my hair, it came in a little thicker and wavier than it had been before.  Since the transplant, though, it’s coming in baby-fine, which may be part and parcel of the new immune system I’m growing.  I always wished my hair was straighter and finer, so I like it, as well as the short length.  Always look for that silver lining!




Here was my chemo treatment schedule:


Day – 9: 10:00 pm (X mg. Busulfan, IV drip)*

Day – 8: 4 am, 10 am, 4 pm, 10 pm (X mg. Busulfan, IV drip)

Day – 7:  4 am, 10 am, 4 pm, 10 pm (X mg. Busulfan, IV drip)

Day – 6:  4 am, 10 am, 4 pm, 10 pm (X mg. Busulfan, IV drip)

Day – 5:  4 am, 10 am, 4 pm (X mg. Busulfan, IV drip)

Day – 4:  10 pm (800 mg./40 ml soln. Etoposide – 2 hr. syringe pump)

Day – 3:  10 am (800 mg./40 ml soln. Etoposide – 2 hr. syringe pump)

                12 am (X mg. Cytoxin)

Day – 2:  10 am (800 mg./40 ml soln. Etoposide – 2 hr. syringe pump)

                12 am (X mg. Cytoxin)

Day – 1:  OFF (no chemo)

Day 0:     Transplant

* Other oral and IV meds started (and continued) during the course of my chemotherapy:

a)     Ativan (anti-nausea and anti-anxiety)

b)     Zofran (anti-nausea)

c)     Compazine (anti-nausea)

Your Chemo or Radiation Schedule:

I’ll give you a total of 10 days to work with, although usually 2-8 days is sufficient.  Make sure and start with your correct day as calculated in your countdown and leave the others blank.  Note your ‘OFF’ day if you have one scheduled between your treatment and transplant (if you have an OFF day it will always be on Day – 1).

Day – 10 :  _______________________________________________________________

Day – 9:     _______________________________________________________________

Day – 8:     _______________________________________________________________

Day – 7:     _______________________________________________________________

Day – 6:     _______________________________________________________________

Day – 5:     _______________________________________________________________

Day – 4:     _______________________________________________________________

Day – 3:     _______________________________________________________________

Day – 2:     _______________________________________________________________

Day – 1:     _______________________________________________________________

Day 0:    Transplant

Note any additional anti-nausea or anti-anxiety meds they offer or prescribe during this time: ___________________________________________________________________

________________________________________________________________________

________________________________________________________________________



Generally you will feel no sensation of discomfort or anything odd in particular during either the chemo or radiation sessions.  There are side-effects, however, although they may take several days or a week before they manifest themselves.  I’ll cover these side-effects later in this page.



You might have some trouble sleeping during this time – either due to the treatment or simply from the anxiety of an extended stay in a foreign environment.  Don’t hesitate to ask your nurse for a sleep aid if you feel the need.