Canterbury DHB

Context

Pre-Transplant Patient Assessment

In This Section

Initial Patient Assessment

Initial Patient Assessment

History of the disease and its treatment, assessment of the current disease status, and an assessment of the patient's fitness to undergo the procedure are required before proceeding with treatment. If the patient is referred from outside Christchurch, their hospital notes, bone marrow slides, and any relevant histology specimens will need to be obtained. The details of treatment should include:

It is the responsibility of the SCT Coordinator to make the required arrangements (see the remainder of this section for details) and complete the Pre-Haematopoietic Stem Cell Transplant Check List.

Previous Malignancy

A previous history of any malignancy needs full documentation and discussion with the Consultants signing the transplant protocol. In particular, obtain details of previous melanoma, including vertical thickness, ulceration, infiltration into nerves or vascular channels, lymph node involvement, sites involved, and number. It may be necessary to request copies of histology reports and discuss with the doctor who was responsible for their excision. An Oncology review is advised for any patient referred to the Bone Marrow Transplant Committee with a prior history of melanoma, to assess reactivation risk.

Dental Consultation

This needs to be done within 2 months of SCT but at least 3-4 weeks prior to admission in case dental extractions etc are needed. Patients are referred to the Dental Department, Christchurch Hospital (Ext. 80250), using the Dental Referral Form. Urgent referrals can also be emailed to oralhealthcentre@cdhb.health.nz which is triaged twice daily.

Fertility Issues

See Fertility and Menstruation Issues for full details, including:

Gynaecological Allogeneic Transplant Pathway

Gynaecological Allogeneic Transplant

TBI Planning

This is done 3-4 weeks before conditioning starts. The BMT Co-ordinator writes a referral letter (see template referral letter in G drive\HAE\BMT\Templates) to the Radiation Oncologist (Dr Brendon Anderson, or if he is not available Dr. Stephen Williams) with all patient details, past treatment, details of type of transplant, protocol being used (if applicable), radiation doses required as per protocol or details of any deviations to the protocol and the name of the patient's lead Haematologist. A copy of this letter is also sent to the Radiation Therapist, who will organise the Radiation Oncologist’s appointment and the planning appointment. Sometimes this will include a CT scan, which is organised by the Radiation Therapist. The patient is seen by the Radiation Oncologist for education, assessment, and consent for TBI.

Respiratory Function Tests

There is a standard panel of pre-SCT tests (spirometry, static lung volumes, diffusing capacity, and arterial blood gases). These are performed in the Respiratory Physiology Laboratory at Christchurch Hospital and need to be arranged in advance. Phone the receptionist to organise an appointment date and time. Complete a referral and fax to 80878. Make sure you inform the patient of the appointment.

Echocardiograms

This is mandatory for all transplant patients. Complete the referral form and fax to 81120. Include other appointments on the referral, e.g., respiratory function, so appointments can be made on the same day to avoid too many trips to the hospital.

Renal Function

Calculate Cockcroft and Gault creatinine clearance. If GFR <50 ml/min, consider either reduction in the dose of conditioning drugs, or not doing the planned SCT. Discuss with Consultant.

Audiometry

Certain conditioning schedules, e.g., platinum containing regimes, require audiometry assessment pre SCT. Phone 80970 to arrange.

Chest X-Ray and Sinus CT

These are mandatory pre-transplant tests for allogeneic transplant patients. The request forms should be faxed to 81039, CT appointments. Both procedures can be requested on one form, and are to be done 1 week prior to admission.

Autologous transplant patients required chest X-ray only.

Hickman Catheter

If there is no central venous access, arrangements will need to be made for the insertion of a triple lumen Hickman catheter. This is performed under local anaesthesia and sedation in DSA (ext. 81417). This can be done as an outpatient through the Haematology Day Ward. Ideally it should be inserted 1-2 days before conditioning is due to start.

Disease Restaging

Disease restaging appropriate for the individual patient must be done to define disease status pre-transplant. Pre-transplant bone marrow assessment is essential. Decide what extra tests (if any) need to be taken from the bone marrow (discuss with the Transplant Consultant).

Psychological Assessment

All patients are to be seen by the psychologist as soon as the decision for transplant is made. A referral is sent to Lois Surgenor, by email or fax 81432 Haem OPD.

Nutritional Assessment

An appointment will be organized with the dietitian prior to admission.

Pharmacist

The Pharmacist sees the patient on admission, to discuss conditioning chemotherapy and any immunosuppressive drugs (if these are to be used). The Pharmacist will also provide discharge scripts and yellow cards.

Social Worker

The Social Worker provides travel and accommodation assistance if required, and discusses the patient's support systems.

Blood tests required

Note: Autologous PBSC recipients with an adequate harvest (≥ 2 x 106 CD 34+ cells/kg) do not need routine HLA class 1 typing pre-PBSCT, as such patients are unlikely to require HLA matched platelets post-PBSCT. However, autologous stem cell recipients, in whom platelet recovery may be delayed, will have class 1 typing performed in case HLA matched platelets may be required. Such patients include those with a bone marrow harvest and/or poor quality PBSCH (<2 X 106 CD34+ cells/kg).

BMTU Visit

For patients who have not previously been inpatients in the Clinical Haematology Unit, a visit to the Unit with an opportunity to meet the Unit Nurse Manager, Occupational Therapist, Dietitian, Physiotherapist, and Social Worker prior to admission is desirable. This is arranged through the SCT Co-ordinator (pager 8412), who will also provide supporting information booklets.

Investigations Pre-Conditioning

The following investigations are required in the week before conditioning.

Adult patients should have perinasal swabs taken. Test for RSV, adenovirus, influenza A and B, parainfluenza type I, II, and III. Transplantation should be deferred if symptoms of URTI are present or if the result of viral screening (especially of RSV) is positive. Allogeneic recipients are at higher risk from RSV.

If possible, all SCT candidates and close family contacts should also be immunised with the current influenza vaccine during the influenza season preceding SCT. An attempt should also be made to immunise a family donor with the influenza vaccine one month preceding SCT. These measures form part of a preventative strategy which is outlined in an information sheet for patients and their relatives.

The following tests are performed on admission:

Patient Information Checklist

See the Pre-transplant Checklist.

It is important to discuss and document details and potential complications of stem cell transplant procedures and to provide information as appropriate. This task is usually a composite one, including the patient's Consultant, BMT Registrar, and BMT Coordinator.

Patient Consent

These should not be left to the last minute and will be required for harvest (NZBS to do), conditioning, and stem cell reinfusion procedures, relevant research or clinical trial protocols, and consent to send information to international registries.

Transplant Protocol Distribution List

A copy of each patient's transplant protocol is sent to the following people to assist them in planning their portion of the patient’s care.

SCT Coordinator Desktop Information Folder

There is a paper version of practical details, addresses, contacts, etc., held in the SCT Coordinator's office.

About this Canterbury DHB document (9457):

Document Owner:

Andrew Butler (see Who's Who)

Issue Date:

December 2016

Next Review:

December 2018

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 9457