A stem cell transplant is an infusion of healthy stem cells. Stem cells are located within the bone marrow and are the cells from which all other blood cells and the immune system are created.
Introducing healthy stem cells into the blood enables the production of all of the different parts of the blood that both the body and the immune system need. Stem cell transplants offer some patients the possibility of a cure, and others a longer period of disease-free survival.
Transplants are used to treat several types of blood cancers and other blood disorders, including:
Doctors may consider a transplant when:
- The body cannot make the blood cells it needs, usually because the bone marrow or stem cells have failed,
- The body’s bone marrow or stem cells have become diseased, or
- A patient’s disease is treated with such high-doses of chemotherapy and/or radiation therapy which destroys cancer and healthy stem cells at the same time. In this case, the transplant replaces the stem cells lost during treatment.
In some cases, stem cells are harvested from a patient’s own blood to be transplanted back after conditioning treatment that kills cancerous cells. This is an autologous transplant.
An allogeneic transplant uses stem cells from a donor (related or unrelated to the patient) whose human leukocyte antigens (HLA) are acceptable matches to the patient’s.
The First Step is Evaluation and Testing
Stem cell transplants can be a difficult process. Your doctor will evaluate if you are a good candidate for transplant and discuss the process and effects with you.
Evaluation may include:
- Age, health history, and physical exam
- Psychological and emotional consultations
- Identifying a primary caregiver
- HLA tissue typing (for patients requiring donor stem cells)
- Bone marrow biopsy
- Heart and blood tests
- Imaging scans
- Lung function tests
- Tuberculosis skin test
- Chest X-ray
- Consultations with transplant team
When a patient is identified as a stem cell transplant candidate, the care team will create a treatment plan based on your type of cancer, the type of transplant, and your treatment history. The team will also provide education about the transplantation process. If a donor is needed, the team will also begin the donor search process.
Next is Conditioning Treatment
Chemotherapy and/or radiation therapy may be used prior to the transplant in an effort to:
- Make room for transplanted cells
- Suppress the immune system to decrease the risk of rejection
- Kill remaining cancer cells
Patients are admitted to the hospital for conditioning treatment.
Side effects of conditioning may include mouth sores, nausea and vomiting, fatigue, dry mouth, hair loss, and breathing problems.
After Conditioning, you Are Ready for the Infusion of Healthy Stem Cells
through a central line in your chest.
Side effects during or after infusion may include:
- Fever or flushing
- Shortness of breath
During the acute recovery period immediately after the infusion of healthy stem cells, the new stem cells begin to engraft. This is when your transplanted stem cells begin to make new blood (red blood cells, platelets, and other components of the immune system) within your body.
The time it takes to reach engraftment depends on several factors, including stem cell source, the type of transplant, and your pre-transplant therapies.
Though every patient is different, most patients are in the hospital for 1-4 weeks. There are several factors that determine when you may be discharged from the hospital. This includes:
- Your blood counts
- Being free from fever and other clinical indications
Frequent follow-up visits are needed even once you return home so your care team can monitor your blood counts and address any side effects that you experience.
Full recovery to normal blood counts may take up to one year, during which your care team may place limitations or restrictions on your interaction with others, food, pets or plants to reduce your risk for infection while your immune system is recovering.
Transplantation has a long recovery process, but with time you will start to feel better.
The National Bone Marrow Transplant Link helps patients, caregivers, and families by providing information and support services before, during, and after transplant.
1-800-LINK-BMT (1-800-546-5268) or online at www.nbmtlink.org.