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Cancer Care Chronicles
November 27, 2019

The “Art” of Bone Marrow Transplantation

Author Affiliations
  • 1Hans Messner Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
  • 2Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
JAMA Oncol. 2020;6(2):189. doi:10.1001/jamaoncol.2019.4738

One can never truly prepare a patient for the long and arduous journey that is bone marrow transplantation. Every transplanter encounters this unfortunate situation at least once in their career: a patient’s lament that had they known it could get this bad, they would not have gone through with it.

When faced with the choice between length of life and quality of life—when offered the chance of cure (not a term used lightly in hematology-oncology) at the risk of considerable morbidity and potential mortality—patients make decisions that others may find inexplicable but that are as unique as their own personalities, priorities, and goals of care. Faced with the toxic effects that invariably accompany transplant conditioning, it is not uncommon for patients to lose hope and enter a state of despair where recovery appears a distant dream, never to be attained. Occasionally, one may enter into the uncooperative and/or depressed phase where they state that they have “had enough” and want to stop treatment, go home, and move on from this world.

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