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Hematopoietic Stem Cell Transplantation

(HSCT; Bone Marrow Transplantation (BMT); Peripheral Blood Stem Cell (PBSC) Transplantation; Cord Blood Transplantation)

Definition

Hematopoietic stem cells make red blood cells, white blood cells, and platelets. Sometimes, stem cells in your bone marrow do not work well or need to be destroyed to help treat a disease. Hematopoietic stem cell transplantation (HSCT) can replace these stem cells.

It may take about a month for the new stem cells in the bone marrow to start to function fully. If the HSCT works, new bone marrow cells will make healthy red blood cells, white blood cells, and platelets.

HSCT may be done using stem cells from:

  • Your own bone marrow or blood and stored
  • A donor's bone marrow or blood

Location of Active Bone Marrow in an Adult

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Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure    TOP

HSCT is done if the stem cells in your bone marrow are not working or are lacking. This may be caused by:

  • Infection
  • Cancer, such as leukemia and lymphoma
  • Cancer treatment such as chemo- and radiation therapy
  • Problems with the immune system
  • Severe anemia—lack of red blood cells or hemoglobin in the blood
  • Blood disorders, such as sickle cell disease and thalassemia

Possible Complications    TOP

Problems are rare, but no procedure is free of risk. If you are planning to have HSCT, your doctor will review a list of problems that may happen, such as:

  • Infection—until the donor blood-forming cells begin to work
  • Rejection of the donor stem cells
  • Acute graft versus host disease—when the immune cells in the donor's bone marrow attack your tissue

Possible problems for the donor are:

  • Bleeding
  • Infection

HSCT is usually avoided if you have:

  • Disease of the heart, lungs, liver, or kidneys
  • Diabetes

Talk with your doctor about your risks before having HSCT.

What to Expect    TOP

Prior to Procedure

The donor will be tested to check for diseases. Both you and the donor will be tested to make sure that your tissues match. Certain markers on the blood cells and bone marrow cells must match for HSCT to work.

The person having HSCT will be given medicine to lower the immune system. This is to try to stop your body from rejecting the donor stem cells. In the weeks before HSCT, you may need 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 stay asleep
  • Recipient—will not need any anesthesia

Description of the Procedure    TOP

If the stem cells will be from the donor's bone marrow, an area of the donor's hip will be cleaned. 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, the doctor will stick a needle in the donor's large vein or veins in the arms. A machine will collect 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 puncture wounds will be covered with bandages. You may need more than one blood donation. The donor may also need to take pills that cause more stem cells from the bone marrow to go into the blood.

The donated stem cells will be filtered. The cells will be delivered into one of your large veins through a small, bendy tube called a catheter.

Immediately After Procedure    TOP

The donor will get better quickly. You, the recipient, will need to be placed in a room by yourself. This is so you don’t get an infection before the new stem cells in the bone marrow start to make infection-fighting cells.

How Long Will It Take?    TOP

  • Donor
    • Bone marrow transplant (BMT)—about 30 minutes
    • Peripheral blood stem cell (PBSC)—several hours
  • Recipient—several hours

How Much Will It Hurt?    TOP

  • Donor:
    • If the procedure done is a BMT,then the donor will have general anesthesia during the transplant. There may be pain 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    TOP

  • Donor
    • For BMT—overnight
    • For PBSC—several donations, each lasting a couple of hours
  • Recipient—1-2 months

Post-procedure Care    TOP

The donor may receive:

  • Pain relievers
  • Antibiotics to prevent infection

While you are recovering at the hospital, you may have:

  • Medicine that keeps 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 find out whether the new stem cells in the bone marrow are taking hold or being rejected

Call Your Doctor    TOP

Contact your doctor if your recovery is not progressing as expected or you have problems, such as:

  • Nausea and vomiting
  • New pain more than 24 hours after the transplant
  • Redness, swelling, excessive bleeding, or discharge from the catheter site
  • Signs of infection, such as fever and chills
  • Rash
  • Diarrhea

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

Be the Match—National Marrow Donor Program
https://bethematch.org

CANADIAN RESOURCES:

Canadian Association of Transplantation
http://www.cst-transplant.ca
Canadian Blood Services
https://www.blood.ca

References:

Blood-forming stem cell transplants. National Cancer Institute website. Available at:
...(Click grey area to select URL)
Updated August 12, 2013. Accessed September 6, 2016.
Stem cell transplant for cancer. American Cancer Society website. Available at:
...(Click grey area to select URL)
Accessed September 6, 2016.
Last reviewed May 2016 by Mohei Abouzied, MD
Last Updated: 5/17/2018

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