What to Expect in a Stem Cell Transplant

What Is a Stem Cell Transplant and What Is It Used to Treat?

A stem cell transplant (SCT) is a process where non-functioning, deficient bone marrow or cancerous cells are eliminated by chemotherapy and/or radiation and then replaced by new, healthy cells.  This process is also known as a hematopoietic stem cell transplant (HSCT), bone marrow transplant or blood and marrow transplant (BMT).  These healthy cells are called stem cells or hematopoietic stem cells (HSC).  The HSC can be collected through the bone marrow (bone marrow transplant) or through the peripheral blood (peripheral blood stem cell transplant). Hence the term, “blood and marrow transplant”. Most transplants are done collecting the HSC through the peripheral blood because it is easier for donors to go through. Though there are certain diseases that specifically use stem cells collected through the bone marrow.

A stem cell transplant is typically used to treat blood cancers, but it can also be used to treat other disorders that reduce the number of healthy blood cells in the body. At OhioHealth, these transplants are part of our Blood and Marrow Transplant Program.

Conditions treated

Stem cell transplants may be used to treat:

• Blood cancers, including leukemia, lymphoma multiple myeloma, and light chain amyloidosis
• Bone marrow failure syndrome such as aplastic anemia
• Hereditary blood disorders and congenital diseases that cause bone marrow failure
• Other cancers, like testicular cancer or ovarian germ cell cancers
• Autoimmune diseases, such as multiple sclerosis or systemic lupus

How Does a Stem Cell Transplant Work?

When healthy stem cells are infused into the bloodstream, they travel to the bone marrow and replace diseased marrow. They also help bone marrow start producing healthy blood cells again.

What Are Bone Marrow and Hematopoietic Stem Cells?

Bone marrow is a soft, spongy material found inside your bones. Hematopoietic stem cells are housed within the bone marrow. Hematopoietic means blood-forming. They either divide to form more blood-forming cells or they mature into one of three types of blood cells:

• White blood cells to fight infections
• Red blood cells to carry oxygen throughout the body
• Platelets to help blood clot

While most hematopoietic stem cells are found in the bone marrow, some are found in the bloodstream. These are called peripheral blood stem cells, or PBSCs. Hematopoietic stem cells can also be found in blood from the umbilical cord. Stem cells from all three of these locations can be used to perform a blood and bone marrow transplant.

What Are the Different Types of Transplants?

There are two types of stem cell transplants:

Autologous transplant. With an autologous transplant, the healthy cells come directly from the patient. The cells are collected from the patient and frozen to be used at a later time.

After the patient has responded to their initial chemotherapy (induction chemo) to get their disease under control, the stem cells are collected. The patient will then receive a high-dose chemotherapy that will eliminate diseased bone marrow which can improve the patient’s response they have had from their initial chemo and make it last longer. The collected stem cells are then infused after this high-dose chemo.

The stem cells then work their way to the bone marrow and trigger it to produce more healthy blood cells. A major benefit of autologous transplant is that there is little to no risk of the patient’s body rejecting the cells or of the transplanted cells attacking the body.

Allogeneic transplant. When the cells come from another person (donor), it is called an allogeneic transplant. With this type of transplant, the first step is trying to find the donor who is the best match. This usually starts with testing close family members. If a match is not found within the family, many turn to other sources. These include the National Marrow Donor Program or publicly stored umbilical cord blood bank registries. The BMT Nurse Coordinator works with these other sources to identify donors that are a match for the patient.

New transplant procedures are making it possible to use donors who are not an exact match. However, the better the match, the less likely the recipient’s body is to reject the cells or develop complications.

What Should Recipients of Stem Cell Transplants Expect?

Before stem cell infusion (before transplant day)

When you are scheduled for a transplant, you are admitted to the hospital a few days before stem cell infusion. This is when the conditioning regimen begins.

The conditioning regimen consists of high-dose chemotherapy with or without radiation.  The goal here is to kill the abnormal cells, as well as prepare your immune system to accept the transplanted cells. 

During the stem cell infusion (transplant day)

The infusion of the stem cells is simple and takes between one and five hours. The healthy cells will be administered through a narrow tube that is inserted into a vein, like getting a blood transfusion.

Upon entering the bloodstream, the stem cells will then find their way to the bone marrow, where they will begin a process called engraftment. Engraftment is when your body begins to produce healthy new red and white blood cells and platelets.

After the stem cell infusion (after transplant)

Depending on your type of transplant, engraftment usually takes place between 1 and 3 weeks after the transplant. Your blood counts will be checked daily to monitor when new blood cells begin to grow in your bone marrow. In addition to producing new, healthy cells, your immune system also needs time to recover.

After the transplant, you’ll stay in the hospital for about 2 to 4 weeks (sometimes more). However, it may take several months for your immune system to fully recover after autologous transplants and up to 2 years after allogeneic transplants. When it’s time to leave the hospital, you’ll be given detailed instructions on how to avoid infection and other complications and you’ll continue to be monitored in an out–patient clinic.

Possible complications

Every medical procedure comes with risks, including stem cell transplantation. Two notable risks for allogeneic transplant include the possibility of rejecting the donor cells (very low 2-6%) and the possibility of the donated cells attacking the body (graft-versus-host disease or GVHD). There is no rejection or GVHD when the patient gets his/her own cell (autologous).

Recipients of donor stem cells start taking medication to help reduce the risk and intensity of GVHD before the transplant. GVHD is when the donor stem cells recognize the recipient as foreign and start attacking them. Those attacks show up as skin rashes, diarrhea, and other problems. Some minor GVHD symptoms are normal and shows that the transplanted cells are working.

In addition, the medicine and radiation used before the transplant can cause stomach problems, fatigue, hair loss, liver damage, and more. There is also an increased risk of infections when your immune system is weakened from these treatments.

What Should Stem Cell Donors Expect?

Before donating

A simple cheek swab is the first step in determining if you’re a good match for a stem cell transplant recipient. From the swab, doctors will compare the recipient’s human leukocyte antigen (HLA) to yours. HLA is a protein found on most cells in your body. Your immune system uses it to know which cells belong in your body and which do not. Specific HLA markers need to match for the possibility of a successful transplant. The donor will undergo a physical exam and do blood work to make sure they are fit to donate. The health of the donor is the #1 priority.

During the donation

Most donors will have their stem cells collected through the peripheral blood, the same way an autologous patient will collect their own stem cells. The donor will receive medication in the form of injections or shots. Donors can give the shots to themselves over several days. They can also choose to go to a designated healthcare provider to receive the injections every day up to the day of collection. This medication helps to encourage growth of the hematopoietic stem cells in the bone marrow and pushes them out into the blood stream. The stem cells are then collected from the blood stream through the veins. It’s a similar process to how one donates blood or plasma or platelets, just this time, we are collecting stem cells.

In a small percentage of diseases, we require these stem cells to be collected through the bone marrow. For that process, the donor receives general anesthesia to make them sleep during the procedure. The bone marrow stem cells are then collected from the pelvic bones called the iliac crest, using bone marrow aspiration needles. This procedure is called bone marrow harvesting and takes about one hour. Donors usually spend a couple of hours in a recovery room to make sure they recover from the anesthesia and have no other concerns from the procedure before going home.

After the donation

For a few days, a bone marrow donor may feel some discomfort where the bone marrow was harvested and may also feel tired. Within a few weeks, their body will replace the harvested marrow. Some donors can expect to be back to their normal activities within a couple days, while others may take a few weeks to fully recover.

Possible complications

Donating stem cells by peripheral blood or by bone marrow rarely causes any significant problems for the donor. In fact, the most serious risk is associated with the anesthesia used during the procedure for bone marrow donors.

How Can I Become a Stem Cell Donor?  

Donating stem cells is an extremely safe and relatively simple way to save a life. To learn about donor eligibility guidelines, contact Be the Match or the donor center in your area.

You can also learn more about being a bone marrow donor by visiting the American Cancer Society website.  

To learn more about stem cell transplants at OhioHealth, visit our Blood and Marrow Transplant Program page.

To learn more about our comprehensive cancer care programs and services, visit OhioHealth.com/Cancer.