What’s the Process Involved in a Stem Cell Transplant?

Written by: Beth Dougherty

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 with blood cancers and blood disorders 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: 

A stem cell donor undergoes stem cell collection.
A stem cell donor undergoes stem cell collection.

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. 

With a more than 50-year history of stem cell transplantation innovation, Dana-Farber Cancer Institute experts have been leaders in advancing the field. Examples of progress include: 

  • A way to use monoclonal antibodies to cleanse a patient’s bone marrow of cancer cells, improving stem cell transplantation outcomes. 
  • A way to reduce the intensity of chemotherapy prior to stem cell transplantation to enable more older people to benefit from the procedure. 
  • Efforts to understand and develop medicines to manage graft-versus-host disease, a condition where the transplanted cells attack the patient’s healthy cells. 

Today, researchers at Dana-Farber are focused on continuing to reduce or eliminate relapses of cancer after stem cell transplantation.  

Learn more about the Adult Stem Cell Transplant Program at Dana-Farber. 

The First Step is Evaluation and Testing

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
  • EKG
  • 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 often admitted to the hospital for conditioning treatment, but some patients may also receive conditioning treatment in the outpatient clinic. 

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
  • Chills
  • Headache

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

Outpatient transplant, where most treatment is provided in the outpatient clinic at Dana-Farber’s Yawkey Center for Cancer Care, is also a possibility for some patients.  

Frequent follow-up visits are needed 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. 

Learn more about the different typesof stem cell transplants and stem cell transplant services at Dana-Farber. 

Learn the difference between autologous and allogeneic stem cell transplants. 

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) 

The Blood and Marrow Transplant Information Network also provides valuable information for patients, caregivers, and families.  

2 thoughts on “What’s the Process Involved in a Stem Cell Transplant?”

  1. My wife Beverly underwent a stem cell transplant in 2016 from a sibling match. She had AML leukemia. However after only several weeks the transplant failed and after nine months since diagnosis my wife passed away in Jan. 2017 at only 62. She had been a patient at BIDMC with Dr. McMasters. Very sad. More needs to be done to help some of these young seniors survive AML. I know LLS is trying hard with their new Beat AML program.

  2. I was a pioneer in stem cell transplants. I had an experimental protocol for stage 3 b breast cancer with 19 out of 29 pos lymph nodes…. I had high dose chemo which took all my cell counts Down to the hundreds and an adult stem cell transplant rescue. It saved my life and I have bee cancer free for 23 yrs!!

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