Stem cell transplants have become important weapons in the fight against certain blood cancers, such as multiple myeloma, non-Hodgkin’s lymphoma, Hodgkin lymphoma, and leukemia. A stem cell transplant may help you live longer. In some cases, it can even cure blood cancers.
About 50,000 transplantations are performed yearly, with the number increasing 10% to 20% each year. More than 20,000 people have now lived five years or longer after having a stem cell transplant.
Here’s how it works: The stem cells in healthy bone marrow produce blood cells, including the white blood cells that are crucial to your immune system. Blood cancers themselves damage your bone marrow, and so do chemotherapy and radiation treatments for the cancers. A stem cell transplant lets new stem cells take over from your damaged marrow so your body can produce healthy, cancer-free blood cells.
Your doctor may want to use stem cells taken from your own blood, or stem cells from a donor. If you use your own stem cells, your blood will be drawn when your cancer is not active. If you use a donor’s cells, your doctor will first need to find a matching donor. Either way, you will have chemotherapy and/or radiation beforehand. This will kill the cancer cells and destroy your damaged stem cells so the transplanted stem cells can take over.
If you use your own cells, you may be able to have an outpatient stem cell transplant. You need to have no other serious medical conditions, have a caregiver who can monitor you at home, and live within an hour of the hospital. Your home environment must be carefully prepared, and you must wear a mask when going out.
Here’s what to expect from the transplant process.
- You or the donor will get injections of special medicines four or five days before the blood draw. These medicines move blood-forming stem cells from your bone marrow into your bloodstream.
- Your blood or the donor’s will be drawn. The stem cells from your or the donor’s bloodstream will be separated from the rest of the blood and frozen.
- You will have “conditioning treatment.” This will be either high- or low-dose chemotherapy and/or radiation. Its purpose is to kill the cancer cells and destroy your own stem cells — destroying your immune system in the process — so the transplanted stem cells can take over.
- You will have an infusion of the stem cells. You’ll sit in a comfortable chair for several hours as the infusion is given through a central line (a surgical port in your neck).
- Nurses will monitor you. They will check to be sure you are not developing fever, chills, hives, or a drop in blood pressure.
- You might have mild side effects, including headache, nausea, flushing, or shortness of breath.
- Your new immune system starts to work. After two to four weeks, the new stem cells graft to your bone marrow and start to make new white blood cells. Next, your body starts making platelets, then red blood cells.
- If you received donor cells, you will get antibiotics and anti-rejection drugs to help your body accept the transplanted cells. You may also need transfusions of red blood cells and platelets as well as intravenous nutrition.
- You must stay in a germ-free environment for the first few weeks. If you have a transplant with donor cells, you will probably stay in the hospital for about a month until your new immune system starts working. You will need filtered air and your visitors must wear masks.
- You will make regular visits to the outpatient clinic for six months. The transplant staff will test your blood or bone marrow for levels of healthy blood cells and check for any complications. After that, your own doctor will continue to care for you.
You’ll feel tired for the first few weeks. It may be several months before you can resume your normal schedule. About two months after the transplant, your doctor will draw blood and may take a sample of bone marrow from your hip to see that you are producing all types of blood cells. The bone marrow will also show which cells are being formed, yours or, preferably, the donor’s. This is known as chimerism. Your doctor will also want to see that you have no major complications.
