Stem Cell Transplant Process

What Is Blood and Bone Marrow Transplantation?

The cells and platelets in our blood play an important role in your body's function.

  • White blood cells (leukocytes) fight infection.
  • Red blood cells (erythrocytes) carry oxygen to organs and tissues and then carry away waste products.
  • Platelets help you to stop bleeding when you cut yourself.

When these cells become diseased and unable to perform their job, organs and tissues are affected. The result can often be life-threatening.

The goal of a bone marrow or blood cell transplant is to replace the cells that don't work with ones that do. Your condition and specific disease will determine the type of cells for transplantation. Your doctor will discuss this with you. These new cells can be harvested for transplantation from three sources:

  • Bone marrow
  • Blood circulating in the body, called peripheral blood
  • Blood collected from umbilical cords when babies are born, called cord blood

A second decision that must be made for transplantation is the source of the new blood-forming cells. The sources could be:

  • The patients own cells
  • Cells from someone else

The different types of transplants are described according to the source of the blood cells. They are:

  • Autologous - Uses your own cells from your bloodstream or bone marrow
  • Related allogeneic - Uses cells from one of your family members
  • Unrelated allogeneic - Uses cells from an unrelated matched donor
  • Reduced-intensity transplant (sometimes called a mini-transplant) Requires less intensive treatment with chemotherapy or radiation
  • Umbilical cord blood transplant
  • Syngeneic - Uses cells from an identical twin

How Is the Transplant Done?

The actual transplantation of new cells is done through your central venous catheter (CVC). A hollow tube is inserted into a vein and medicine or other fluids travel through. The new cells are delivered through the CVC into the vein. This is called an infusion. Most patients find the infusion relatively easy and painless.

The infusion is followed by pre-transplant conditioning. This allows the healthy, infused cells to establish themselves within the body and function normally.

Finding a Donor Match

If your doctor decides you will need to seek donor cells for an allogeneic transplant, the first potential source to consider will be a family member. Your best chance of finding a match usually is a brother or sister.

For transplantation to work, the donors tissue type must match the patient. This match is different from blood type and involves the human leukocyte antigen (HLA) system. If the HLA does not match, there can be an increased risk for complications, including graft failure and graft-versus-host disease (GvHD).

If no donor is found among your family members, a match may be located through the National Marrow Donor Program (NMDP) registry. The registry accesses millions of donor sources worldwide, including individual donors and stored cord blood units. You will assisted in all aspects of this search by a Vanderbilt-Ingram BMT coordinator who specializes in this area. Your assigned NMDP coordinator will also help you with financial issues related to a donor search. He or she will be available to address any questions and concerns you may have throughout this process.

To learn more about finding a donor match, visit the National Marrow Donor Program.

Importance of Having a Caregiver/Companion

You must have a caregiver/companion with you most of the time as an outpatient during the initial post-transplantation phase. This helper is needed not only to assist with follow-up care, such as flushing IV lines and transporting you to doctor visits, but also to ensure that you get immediate assistance in case of an emergency.

You and your caregiver/companion will participate in a mandatory class taught by a BMT program case manager to prepare for your post-transplantation transition. The program will provide a caregiver's education manual that covers medical, nutritional, social and emotional issues related to being a transplant recipient.

Beginning the Transplant Process

Conditioning begins the actual transplantation process. This term refers to the pre-transplantation phase. You will undergo high-dose chemotherapy and/or radiation therapy to destroy your diseased marrow and blood stem cells. This step kills the bodys normal immune system reaction, so that it wont reject the healthy blood or marrow cells that are transplanted. These transplanted cells should then go through begin producing new, normal blood stem cells within 30 days.

Conditioning may sometimes be done in the Blood and Marrow Transplant Program Outpatient Transplant Unit. You must take extra care of yourself during this period to avoid germ and infection exposure.

Early Recovery After Transplant

The first few weeks after transplantation are critical. You are highly susceptible to infection since your bodys immune system is not functioning yet. Precautions must be taken to avoid germ and infection exposure. Medicines, transfusions and other treatments are used to support you as your healthy, transplanted cells establish themselves and begin new growth, which is called engraftment. This early recovery may take place as an inpatient or outpatient.

As signs of engraftment become evident, patients will not need as much monitoring and medical care. You will then begin preparations for discharge, depending on your specific case and recovery. Some patients will need to stay in the Vanderbilt area for follow-up care for three months or more.

Long-term Recovery After Transplant

Recovery from transplantation varies from patient to patient. It may be a year or more before you are able to resume a normal routine, and you might experience setbacks that require hospitalization or other intensive intervention.

When you are discharged, you will be able to receive follow-up care from your hometown doctor or cancer specialist. The Vanderbilt-Ingram Blood and Marrow Transplant Program provides a manual to help your doctor with this process. Our staff always is ready and willing to answer any questions you or your doctor have at any time.

You may choose to receive your follow-up care at Vanderbilt-Ingrams long-term care clinic. If you receive your follow-up care elsewhere, we suggest that you return to Vanderbilt-Ingram at least once a year for a follow-up assessment.

To maintain the best health possible after a blood and marrow transplant, you may have to make some lifestyle changes, such as not eating foods that have a higher risk of causing a food-borne illness. Overall, you should transition into these minor adjustments with ease.