There are two main types of stem cell transplant - (1) autologous transplant and (2) allogenic transplant. In autologous transplant, the patient's own stem cells will be used. The stem cells will be collected prior to the transplant and will be frozen and re-infused into the patient after high-dose chemotherapy.
In allogenic transplant, stem cells will come from a donor. The donor can either be a family member or a registered volunteer donor. Human-Leukocyte Antigen Typing (HLA Typing) is required to determine the donor's compatibility for transplant.
Preparing for a stem cell transplant and not sure what to expect? Let us walk you through your stem cell transplant journey.
A donor undergoing a health evaluation to test for suitability
Step 1 - Donor Evaluation
Potential donors will undergo a blood test where their white blood cells will be matched against yours. The results will take 3-4 weeks to be available.
Match-related donors are then required to undergo a general health evaluation. Donors should inform the doctor if they have:
High blood pressure
Any other illnesses
Pregnant or breastfeeding mothers are advised against donating stem cells.
A patient preparing for Stem Cell Harvesting
Step 2 - Stem Cell Harvesting / Bone Marrow Harvest
There are two main ways in which stem cells are collected.
The first is Apheresis, which involves harvesting the stem cells from the blood stream using a machine. This removes stem cells from the blood stream and returns the remaining blood cells.
The second is Bone Marrow Harvest whereby stem cells are harvested from both sides of the hipbone.
Injection of growth factor GCSF in preparation of Apheresis
Step 3 - Pre-Transplant
You or the donor are required to undergo daily or twice daily injections of a growth factor, known as GCSF, into the abdomen area over a period of time. The GCSF helps to stimulate and move the stem cells from the bone marrow into the blood stream.
The level of stem cells in the blood stream is measured by a marker known as the CD34+. Once the CD34+ level is suitable, you will be prepared for stem cell collection. Apheresis requires appropriate venous access. The procedure can be carried out through your veins, wherein the nurse will insert two intravenous needles, one in each arm, on the day of harvest under local anesthetic or via a Central Venous Catheter, where a thin flexible tube is inserted through the skin into a large vein situated at the groin area. This is performed under local anesthesia.
Bone Marrow Harvest
Healthy donors are advised to donate a unit of their blood about two weeks prior to the harvest. As bone marrow harvest is performed in the operating theatre under general anesthesia, you or your donor will be scheduled for hospital admission one day before the procedure for blood tests and an anesthetist review. Donors will be required to fast from food and drink after midnight.
The procedure starts with the administration of general anesthesia, skin preparation, followed by insertion of the bone marrow needle into the hipbone to extract the marrow. Multiple punctures are usually required in order to extract sufficient marrow for the transplant. The amount of bone marrow required for a transplant depends on your weight and is usally between 750mLs to 1 Litre.
The marrow collection is then sent to a laboratory for processing.
A patient admitted in the transplant unit
Step 4 - Preparation
When you are admitted to a transplant unit, there will be procedures, investigations and routine activities that need to be carried out and will be part of your daily life in the unit. Some of these activities include:
Measurement of urine, stool and vomitus output
Administration of oral medication or injection of medications
Transfusion of blood products
The medical team will also perform daily ward rounds to check on your progress.
Harvesting of stem cells for transplant
Step 5 - Transplant Process
The transplant process involves these steps:
Stem cells are harvested and prepared for transplant.
During this time, you will undergo a conditioning regime, which consists of either chemotherapy or radiation therapy.
The stem cells are then infused into you.
The process is complete and you will move into the recovery phase.
Transitioning from hospital to home
Step 6 - Post-Transplant
The first few months post-transplant will be focused on your recovery, which includes eating well, avoiding and minimising infections, follow-up appointments with your Doctor and following other guidelines to stay healthy.
You will be more susceptible to certain types of infections due to your low immune system in the first month following the transplant. Other long-term side effects include your body's rejection of donor's graft. However, this is rare due to the rigorous matching and suitability tests conducted before the transplant.
The transition from the hospital to your home will require some preparations to protect you from infections. Ensure your house is thoroughly cleaned, make childcare / pet care arrangements if you have children and delegate any household chores that may expose you to bacteria.
In the months following your transplant, you may feel weak and tired easily. However, you will regain your strength in time with timely medications, adequate rest and exercise.The recovery phase may take about six months to a year. From the preparation for the procedure right down to your recovery, it is important that you work closely with your medical team.