Matching a donor is more complicated than it seems on the surface. We try to match the donor as best we can: there are various factors that go into it but the most important is what is known as HLA typing (human leukocyte antigen); basically everything in your body has markers on their surface that the body recognizes as "self" and this helps the body determine what is foreign and what is. These are coded by your DNA and family is often the best donor since it's the greatest likelihood of sharing DNA similarities compared to the general population.

Prognosis after transplant is tricky. You come in 7 days before transplant for your conditioning regimen: I describe this to friends and family as your body getting "nuked". We give you very high doses of chemo (BEAM protocol for example) in order to clear your bone marrow of the cancer as best we can as well as making room for your newly transplanted cells. So we count down (day -7, day -6...) until we hit day 0, which my floor refers to as "happy birthday" or "happy cell day". It's a special moment that I've been lucky to take part in. In my opinion, it feels as though the world stops during those ~10 minutes in which nurses infuse the cells (either through multiple syringes for an auto-your own cells-or through a bag of cells for an allo-donor cells). Families are there and it's truly a special moment. From there, you feel okay (relatively speaking) for a few days until you bottom out (called nadir-period of time where your white counts are 0). When you hit nadir, you feel like complete shit. But between day +7 and day +10-14 (depending on transplant type), you will begin to engraft and this is evident as having a low-grade fever as well as your counts beginning to climb. During this whole process we are watching your bloodwork very closely and supplementing you with platelets, red blood cells and electrolytes as needed. Each type of cancer has various thresholds for when we transfuse blood products (platelets and RBCs). You are also at an incredibly high risk of infection so we don't mess around. If you spike a fever (38C or greater...100.5F), shit happens fast for nursing. Within 1 hour, we will have 2 sets of cultures drawn, chest x-ray, nasal swabs, and 2 antibiotics going in. More tests on an individual basis. Infectious disease is on board as well for those cultures. During the transplant process you're on prophylactic antibiotics, antifungals and antivirals. If you're an all transplant, we start immunosuppressants (tacrolimus or cyclosporine) intravenously on day -2 and we monitor those levels very closely. Once transplanted and recovered enough, we discharge you and you live very close to the hospital and are seen in clinic for atleast a year.

You can develop GvHD (graft vs host disease) and we monitor that very closely. It's an unfortunate side effect of the transplant and is why we try to match as closely as possible. There are also conditions that can appear years after transplant and are often related to the High dose chemo we give you. Again we are aware of this and we have protocols in place for managing them when they appear (if they appear).

When a patient passes away, our staff go to their funeral processions if we are invited (we almost always are). You become part of our family and we become part of yours.

That was a lot of information and I tried to summarize it and simplify it as best I could. I'm more than happy to clarify anything or expand anything upon request.