SSMC’s Division of Hematology specializes in Hematopoietic Stem Cell Therapy (HSCT). Also known as stem cell transplant, HSCT is a procedure that infuses healthy blood-forming stem cells into the body in order to replace damaged or diseased bone marrow.
There are two types of HSCT: the first is an autologous transplant, which is performed when cells from your own body are used, and the second type is an allogenic transplant where cells from a donor are used.
Diagnosis
Prior to the procedure, you will undergo a series of tests and procedures to assess your general health and the status of your condition and to ensure that you are physically prepared for the transplant. The evaluation could take several days or more.
Treatment
Allogeneic stem cell transplant
An autologous stem cell transplant is most often used to treat conditions such as:
- Hodgkin's lymphoma
- Multiple myeloma
- Non-Hodgkin's lymphoma
Undergoing an autologous stem cell transplant involves:
- Filtering stem cells from the blood (apheresis): A machine is used to filter out the stem cells as the rest of the blood is returned to the body. The stem cells are then frozen and stored for later use.
- Receiving an infusion of stem cells: Stem cells are infused into the bloodstream, where they travel to the bone marrow and begin creating new blood cells.
- Taking medications to increase the number of stem cells in the blood, making their collection easy.
- Undergoing high doses of cancer treatment (conditioning): The patient undergoes high doses of chemotherapy or radiation therapy; and in some cases, both are used.
After an autologous stem cell transplant, you will remain closely monitored and cared for. Our multidisciplinary care team will meet with you frequently to look for any adverse effects and to monitor your body's response to the transplant.
Allogeneic stem cell transplant
An allogeneic stem cell transplant uses healthy blood stem cells from a donor to replace bone marrow that is not producing enough healthy blood cells. Anyone can be a donor as long as they have healthy blood cells – whether they are family members or someone you don’t know.
An allogeneic stem cell transplant serves as an option for people with a variety of cancerous and noncancerous diseases, including:
- Acute leukemia
- Adrenoleukodystrophy
- Aplastic anemia
- Bone marrow failure syndromes
- Hemoglobinopathies
- Immune deficiencies
- Inborn errors of metabolism
- Myelodysplastic syndromes
- Neuroblastoma
Before undergoing an allogeneic stem cell transplant, you'll receive high doses of chemotherapy or radiation to destroy your diseased cells and prepare your body for the donor cells.
Pre-transplant tests and procedures
Post diagnosis, one of our surgeons or radiologists will implant a long thin tube (intravenous catheter) into a large vein in your chest or neck. The catheter, often called a central line, usually remains in place for the duration of your treatment. Your transplant team will use the central line to infuse the transplanted stem cells, medications and blood products into your body.
Collecting stem cells for autologous transplant
If a transplant using your own stem cells (autologous transplant) is to be performed, you will undergo an apheresis procedure to collect blood stem cells. During the procedure, blood will be drawn from a vein and circulated through a machine. The machine then separates the blood into different parts, including stem cells. These stem cells are gathered and frozen, to be used in the future for the transplant. The remaining blood is returned to the body.
Prior to apheresis, you will be administered daily injections of growth factor to promote stem cell production and move them into circulating blood in order to be collected.
Collecting stem cells for allogeneic transplant
If you are to have a transplant using stem cells from a donor (allogeneic transplant), stem cells are gathered from the donor for the transplant.
The conditioning process
Prior to receiving stem cells, you will undergo chemotherapy and possibly radiation to:
- Destroy cancer cells if you are being treated for a malignancy
- Prepare your bone marrow for the new stem cells
- Suppress your immune system
This process is known as conditioning. The type of conditioning you receive depends on a variety of factors, including the disease you have, your overall health and the type of transplant required. Your conditioning treatment may require both chemotherapy and radiation, or just one of these treatments.
During your bone marrow transplant
The bone marrow transplant occurs after the conditioning process has been completed. On the day of your transplant, stem cells are infused into the body through your central line.
After your bone marrow transplant
When new stem cells have entered the body, they travel through the bloodstream to reach your bone marrow. Once there, they begin to multiply gradually, making new and healthy blood cells. This process is called engraftment, which usually takes several weeks - and in some cases more - before the number of cells needed for your body to return to normal is produced. Red blood cells and platelets may also need to be transfused periodically until the bone marrow produces enough (cells?) on its own.
Depending on the type of transplant you undergo and the risks or complications that it entails, you will need to remain near a hospital for a period spanning from several weeks to months to allow close medical care and observation.
Even after being discharged, you may still be susceptible to infections or other complications, so throughout your life, you'll have periodic follow-up appointments with your doctor to ensure there are no late complications.
Medications
Your doctors may recommend medications to assist in avoiding graft-versus-host disease (GVHD) and lessen your immune system's response to these cells in case your bone marrow transplant uses donor stem cells (allogeneic transplant). Since your immune system needs time to recover after a transplant, antibiotics might be administered.
Results
Some disorders can be cured with a bone marrow transplant, while others can be put into remission. Depending on your specific situation, the objectives of a bone marrow transplant involve managing or treating your condition, prolonging your life and increasing your quality of life.
Some patients successfully complete bone marrow transplantation with few difficulties or side effects; others deal with a range of difficult issues, both temporarily and permanently. It can often be challenging to predict how serious the side effects will be and whether the transplant will be successful before the transplant because they vary from person to person.
