Hematopoietic Stem Cell Transplantation Overview

Stem cells produce red blood cells, white blood cells, and platelets. In some cases, stem cells in your bone marrow may not be functioning well or need to be destroyed to help treat a disease. If this happens, you will need new stem cells.

During this procedure, healthy stem cells are taken from a donor's:

• Bone marrow (bone marrow transplant or BMT)
• Blood (peripheral blood stem cell or PBSC)

The stem cells will be injected into your vein. The new cells travel through the bloodstream to your bone cavities. It may take about a month for the donor stem cells in the bone marrow to begin to function fully. If the transplant is successful, new bone marrow cells will produce healthy red blood cells, white blood cells, and platelets.

Stem cell transplantation may be done using:

• Stem cells that were taken from your own bone marrow or blood and stored
• Stem cells from a donor

Location of Active Bone Marrow in an Adult © 2009 Nucleus Medical Media, Inc.

Prior to Procedure

The donor will be carefully tested to check for diseases. Both you and the donor will be tested to ensure that your tissues are compatible. In order for the transplant to be successful, certain markers, called HLS types, on the blood cells and bone marrow cells must match.

As the recipient, you will be given medicines to suppress your immune system. This is to prevent your body from rejecting the donor stem cells. In the weeks prior to the transplant, you may have to have:

• Chemotherapy
• Radiation therapy

This process is called "conditioning." It will rid the body of diseased cells and clear the bone marrow cavities for the new bone marrow.

Anesthesia

• Donor— general anesthesia to block pain and keep the donor asleep through the procedure; given through an IV in the hand or arm

• Recipient—will not need any anesthesia

Description of the Procedure

If the stem cells will be from the donor's bone marrow (BMT), the doctor will clean an area of the donor's hip. A hollow needle and syringe will be used to remove the bone marrow. The doctor will make several small punctures. This is to harvest enough bone marrow for the transplant (1-2 quarts). Lastly, the wounds will be covered with bandages.

If the stem cells will be from the donor's blood (PBSC), the doctor will stick a needle in the donor's large vein or veins in the arms. A machine will receive blood from the vein. This machine will spin the blood so that the stem cells are concentrated. The rest of the blood will be given back to the donor. The doctor will cover the puncture wounds with bandages. This procedure may require more than one blood donation. The donor may also be required to take pills that cause more stem cells from the bone marrow to go into the blood.

The donated stem cells will be filtered. Next, the doctor will administer the cells through a small, flexible tube, called a catheter, into one of your large veins.

Immediately After Procedure

The donor will recover quickly. You, the recipient, will need to be placed in isolation. This is to avoid infection until the new stem cells in the bone marrow begin to produce infection-fighting cells.

How Long Will It Take?

• Donor

• BMT—About 30 minutes
• PBSC—several hours

• Recipient—several hours

How Much Will It Hurt?

• Donor:

• If the procedure done is a BMT, then the donor will have general anesthesia during the transplant. There may be pain and discomfort after the anesthesia wears off.
• If the procedure done is a PBSC transplant, then the donor will have pain from the needle sticks.

• Recipient—There will not be pain while the stem cells are infused. You may have some nausea. This can be treated with medicine.

Average Hospital Stay

• Donor

• For BMT—overnight
• For PBSC—several donations (each donation lasts a couple of hours)

• Recipient—1-2 months

Post-procedure Care

The donor may receive:

• Pain medicine
• Antibiotics to prevent infection

While you are recovering at the hospital, you may receive the following care:

• Medicines that keep your immune system low to decrease the chance of transplant rejection
• Antibiotics to prevent infection
• Platelets, plasma, and red blood cell transfusions to prevent bleeding and anemia
• Frequent blood tests to monitor whether the new stem cells in the bone marrow are taking hold or being rejected

RESOURCES:

BMT InfoNet
http://www.bmtinfonet.org/

National Marrow Donor Program
http://www.marrow.org/

CANADIAN RESOURCES:

Canadian Association of Transplantation
http://www.transplant.ca/

Canadian Blood Services
http://www.bloodservices.ca/

References:

Berkow R. The Merck Manual of Medical Information. New York, NY: Pocket; 2000.

Bone marrow transplantation and peripheral blood stem cell transplantation . National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/factsheet/Therapy/bone-marrow-transplant . Updated October 2008. Accessed July 21, 2009.