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Stem Cell Transplant Basics

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    What is a stem cell/bone marrow transplant?

    Stem cell/bone marrow transplant offers some patients with benign and hematologic diseases the possibility of a cure, and others a longer period of disease-free survival. Stem cells are the "building blocks" of bone marrow and blood formation. They form white blood cells (which fight infections), red blood cells (which carry oxygen throughout the body), and platelets (which allow blood to clot, helping wounds heal) — all the components your immune system needs to function.

    During a transplant, healthy [hematopoietic] stem cells are transplanted from one individual to another or using an individual's own stem cells to grow and produce all of the different parts of the blood that both your body and your immune system need. You may hear the procedure referred to as a bone marrow transplant (BMT), or a peripheral blood stem cell transplant (PBSCT), or an umbilical cord blood transplantation (UCBT), depending on the source of the stem cells that are used.

    When is a stem cell/bone marrow transplant needed?

    You may need a stem cell/bone marrow transplant when:

    • Your body cannot make the blood cells it needs because your bone marrow or stem cells have failed.
    • Your bone marrow or blood cells have become diseased and need to be replaced.
    • You have a disease that is treated with high doses of chemotherapy and/or radiation treatment, which destroys both cancerous and stem cells at the same time.

    The Stem Cell Collection Process for Autologous Stem Cell Transplant Patients

    This video provides an overview of the stem cell collection process for autologous stem cell transplant patients. It will help patients prepare for their peripheral blood stem cell collection (PBSC), in which their own stem cells are collected and returned to after receiving conditioning chemotherapy.

    What are the types of stem cell/bone marrow transplant?

    There are two main types of stem cell/bone marrow transplant. Your physician will decide what type of transplant should be used for your treatment and the source of the stem cells:

    • An autologous transplant uses a patient's own stem cells. Stem cells are collected from the patient and frozen in liquid nitrogen before transplant conditioning. Following conditioning treatment, the patient's stem cells are returned to the body to help it produce healthy red and white blood cells and platelets.
    • An allogeneic transplant uses stem cells from a donor whose human leukocyte antigens (HLA) are acceptable matches to the patient's. The stem cell donor may be related to the patient or may be an unrelated volunteer found through a donor registry such as the National Marrow Donor Program. There are two main types of allogeneic transplants:
      • A myeloablative transplant uses large doses of chemotherapy — or a combination of chemotherapy and radiation – to overcome resistance and eradicate a patient's malignancy.
      • A reduced-intensity (or "mini" or "RIC") allogeneic transplant uses a reduced amount of chemotherapy to suppress the patient's immune system enough so that the donor stem cells can take root, or "engraft," there. While the chemotherapy may kill some of the tumor cells, that is not the goal of the chemotherapy given prior to the transplant. With the amount of cancerous tissue reduced, the transplanted stem cells produce millions of healthy white blood cells, which mount an attack on the remaining cancer cells — a phenomenon known as the graft-versus-leukemia effect.

    Rizwan Romee, MD, on Haploidentical Stem Cell Transplant

    Rizwan Romee, MD, is the Director of the Haploidentical Donor Transplant Program at Dana-Farber. Dr. Romee explains how research in haploidentical donor transplant has made finding a stem cell transplant donor easier and more convenient for patients.

    What are the possible sources of donor stem cells for allogeneic transplant?

    There are several sources of stem cell donors for allogeneic stem cell/bone marrow transplant patients, including:

    • Related donors: This includes biological family members. Our Donor Services team will work with you and your family members to perform the testing to determine if a family member is an appropriate donor for you. In some cases, we may suggest a haploidentical donor (i.e. 50 percent match) from a biological parent or child.
    • Unrelated donors: Our Donor Services program will search all stem cell donor registries to find an acceptable match. It reviews more than 100 stem cell donor registries across 45 countries, including cord blood registries.
    • Cord blood: Stem cells in the umbilical cord blood of healthy newborns are another potential stem cell source for allogeneic patients.

    Learn more about donating stem cells/bone marrow.

    What is the stem cell/bone marrow transplant process?

    Below are the major milestones in the stem cell/bone marrow transplant process for patients at Dana-Farber Brigham Cancer Center. Most patients are admitted to the hospital for the conditioning chemotherapy, infusion, and recovery stages. However, outpatient transplant — during which a patient receives all of his/her care in Dana-Farber's outpatient clinic — is appropriate for some patients. Your physician will discuss if this is appropriate for your situation.

    Webchat: What to Know About Stem Cell Transplants

    Edwin P. Alyea, MD, associate director of Dana-Farber's Stem Cell Transplant Program, discussed the process of having a stem cell transplant with one of his patients.

      Evaluation

      You will undergo a series of tests and consultations to determine if you are a good candidate for transplant, and to discuss the process and its effects with you.

      Collection or Donor Search
      • Stem Cell Collection for Autologous Patients: For most autologous stem cell transplant patients, stem cells are collected through peripheral blood stem cell harvest using a procedure called apheresis. For some patients, stem cells will be collected through a bone marrow harvest under general anesthesia.
      • Donor Search for Allogeneic Patients: Our experienced Donor Services team will work to find the best possible match for your stem cell transplant. This may be a family member or an unrelated donor who has volunteered to donate stem cells through a donor registry.
      Conditioning

      You will receive chemotherapy and/or radiation to kill the diseased cells. This treatment, known as conditioning, will damage and possibly destroy your bone marrow/blood stem cells. Conditioning therapy generally takes place over 5 to 7 days in your hospital room (or in Dana-Farber's outpatient clinic for outpatient transplant patients).

      Infusion

      You will receive your new, healthy stem cells through an infusion in your central line. Unlike other forms of organ transplant (e.g. heart, kidney) surgery is not required for a stem cell transplant. The infusion generally lasts between 15 minutes to 2 hours.

      Engraftment

      The transplanted cells will begin to grow and produce healthy red and white blood cells and platelets, a process called engraftment.

      Recovery and Discharge

      From your stem cell infusion until engraftment, you may experience several side effects, such as fevers, nausea, fatigue, and difficulty sleeping. As your stem cells engraft and make healthy new blood cells, you will begin to feel better. Though every patient's experience is unique, most patients are ready for discharge from the hospital between 11 to 16 days after their stem cell infusion.

      Follow Up

      You will have follow-up appointments at Dana-Farber or with your local oncologist. These appointments are generally weekly (or 1 to 2 visits/week for allogeneic patients) for a period of time, and then monthly or less frequently depending on your diagnosis, treatment, and recovery.

      Long-Term Care

      Our Stem Cell Transplant Survivorship Clinic helps allogeneic patients manage the effects of their transplant and ongoing health care. The goals of this clinic are to provide a summary of patients' cancer and transplant treatment plans; identify health care challenges and risks resulting from the stem cell transplant; and develop a care plan that outlines recommended screenings and follow-up care to manage any long-term effects of stem cell transplant.

      Patients who undergo autologous stem cell transplant receive survivorship care from a dedicated team embedded within our lymphoma and multiple myeloma programs.

      All patients may consult with additional specialists through Dana-Farber's Adult Survivorship Program. Depending on specific needs, patients may tap experts in cardiology, pulmonology, endocrinology, nephrology, gynecology, sexual health, psychosocial oncology, and exercise physiology — all of whom are focused on helping cancer survivors manage the long-term effects of treatment.

      Stem Cell Donor and Recipient Meet for the First Time

      Three years after receiving the stem cell transplant that cured his advanced myelodysplastic syndrome, a Dana-Farber patient finally meets the German woman who anonymously donated stem cells and saved his life.

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      Celebrating 50 Years of Stem Cell Transplantation

       

      Learn about the history, progress, and innovation in the adult stem cell transplantation program over the past 50 years.

      Explore Our History