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 your own stem cells. Stem cells are collected from you and frozen in liquid nitrogen before transplant conditioning. Following conditioning treatment, your stem cells are returned to your 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 yours. The stem cell donor may be related to you 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 your malignancy.
- A reduced-intensity (or "mini" or "RIC") allogeneic transplant uses a reduced amount of chemotherapy to suppress your 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.
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 transplant process?
The stem cell transplant process involves many steps. You may receive your stem cell transplant care in the hospital (inpatient) or in the outpatient clinic. Inpatient and outpatient stem cell transplants offer the same level of care, safety, and effectiveness. Your transplant physician will recommend the most suitable setting for your transplant, based on several factors, including:
- Availability of a caregiver
- Your diagnosis and treatment plan
- Your overall health status
Inpatient Transplant: If you undergo stem cell transplant in the hospital, you will be admitted for conditioning treatment and remain in the hospital until your new stem cells engraft. The hospital stay is usually 12 to 28 days, depending on your treatment plan and how you feel.
During inpatient transplant, all aspects of care – including conditioning chemotherapy, stem cell infusion, engraftment, and follow-up monitoring – takes place in Brigham and Women’s Hospital or the Dana-Farber Inpatient Hospital (located within Brigham and Women’s). You will stay on a specialized oncology unit designed and staffed to meet your unique needs. You may have visitors according to the hospital’s visitor guidelines.
Each day, the care team will visit you to monitor your vital signs, discuss symptoms, and address any questions. Our inpatient team is very experienced in caring for patients during their stem cell transplant experience.
Outpatient Transplant: With an outpatient transplant, you will receive all your care in our outpatient clinic and return home or to a nearby hotel each day, usually for up to 28 days.
During outpatient transplant, all aspects of care – including conditioning chemotherapy, stem cell infusion, engraftment, and follow-up monitoring – take place in the outpatient clinic at Dana-Farber’s Yawkey Center for Cancer Care, instead of the hospital.
Outpatient stem cell transplants are just as safe and effective as inpatient transplants. The care you receive is the same for both settings. The primary difference is the location. To be considered for outpatient transplant, you must meet the following criteria:
- Treatment plan: Outpatient transplant is suitable for certain treatment plans. Your physician will discuss whether this option is appropriate for you.
- Full-time caregiver: A dedicated caregiver is essential to provide full-time support throughout the 28-day transplant period. The caregiver plays a crucial role in monitoring symptoms and transporting you to and from the clinic.
- Nearby lodging: Patients and caregivers must reside within a specific distance from Dana-Farber during the outpatient transplant period. This could be at your home if it is close-by, or in nearby short-term housing accommodations. Our resource specialists are available to help identify suitable housing options if needed.
Each day, you will visit the clinic to receive treatment, participate in educational sessions with your care team, and meet with your clinical team. If complications arise during the outpatient transplant, you may be admitted to the hospital for additional treatment or monitoring.
Our dedicated care team is committed to preparing and supporting both patients and caregivers throughout the outpatient transplant journey.
What are the milestones in the stem cell transplant process?
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 if you are an outpatient transplant patient).
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 inpatient transplant patients are ready for discharge from the hospital between 11 to 16 days after their stem cell infusion. Outpatient transplant patients will have daily scheduled clinic visits, usually for 10 to 14 days after your 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 your 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 your stem cell transplant.
If you undergo an autologous stem cell transplant, you will 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 your specific needs, you 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.
