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Hematopoietic Stem Cell Transplantation
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Hematopoietic Stem Cell Transplantation

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

En Español (Spanish Version)

Definition

There are three ways in which blood-forming cells (hematopoietic stem cells, or stem cells) can be obtained and then transplanted into a patient. The stem cells may come from bone marrow, donor blood, or umbilical cord blood. Hematopoietic stem cell transplantation is a procedure in which healthy stem cells from a donor's blood or bone marrow are injected into a recipient's vein. The new cells travel through the bloodstream to the recipient's bone cavities. Stem cells are cells that can produce red blood cells, white blood cells, and platelets.

Stem cell transplantation may be performed using blood-forming cells from a donor, called allogeneic transplant . A transplantation may also use stored blood-forming cells from the patient, called autologous transplant .

Parts of the Body Involved

  • Donor—hip bone for BMT or blood vein for PBSC transplant
  • Recipient—blood vein

Location of Active Bone Marrow in an Adult

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Reasons for Procedure

To replace a malfunctioning or deficient blood-forming cells (stem cells) in the bone marrow, which may be necessary in these situations:

Risk Factors for Complications During the Procedure

The risk for complications increases as the recipient's age increases, and in cases where the recipient is severely debilitated.

Stem cell transplant is usually avoided in people with diseases of the heart, lungs, liver, or kidneys, or in people with diabetes.

What to Expect

Prior to Procedure

The donor will be carefully tested to check for communicable disease. Both the donor and the recipient will be tested to ensure that their tissues are compatible. In order for stem cell transplant to be successful, certain markers (called HLA types) on the donor's and recipient's blood cells and bone marrow cells must match.

The recipient will be given medications to suppress the immune system, and therefore prevent the body from rejecting the donor stem cells. In the weeks prior to the stem cell transplant, the recipient may undergo intense chemotherapy and/or radiation therapy. This process rids the body of diseased cells and to clear the bone marrow cavities for the new bone marrow. This process is called "conditioning."

During Procedure

For the BMT, removal of bone marrow from the donor, called "harvesting," takes place in an operating room. The donor receives sedation, anesthesia, and perhaps intravenous fluids. For the PBSC, removal of blood with stem cells is obtained through a needle stick in the vein of the donor's arm. The recipient receives the blood-forming cells (stem cells) in an isolation room, and may require fluids and anti-nausea medications during administration.

Anesthesia

Description of the Procedure

BMT Donor

The area of the hip from which the bone marrow will be harvested is cleaned with an antiseptic solution. A hollow needle and syringe is used to remove bone marrow from the donor's hip bone. Several punctures are made in order to harvest an adequate amount of bone marrow for transplantation (1-2 quarts). The puncture wounds are then covered with bandages.

PBSC Donor

The large vein or veins of the arms will have a needle stuck into them. An instrument called an apheresis machine will receive blood from the vein and spin it so that the stem cells are concentrated. The rest of the blood is given back to the donor. The puncture wounds are then covered with bandages.

This may require more than one blood donation, and may require taking some pills that cause more blood-forming cells to go into the blood from the bone marrow.

Recipient

The donated stem cells are filtered and then administered through a small, flexible tube called a catheter into a large vein in the recipient's chest. Depending on the reason for the stem cell transplantation, the recipient may first require high doses of chemotherapy and/or radiation therapy to completely destroy the blood-forming cells in the bone marrow.

After Procedure

The donor will recover quickly. The recipient will need to be placed in isolation to avoid infection until their new blood-forming cells (stem cells) in the bone marrow begins to produce infection-fighting cells.

How Long Will It Take?

  • Donor—About 30 minutes if BMT or several hours if PBSC
  • Recipient—Several hours

Will It Hurt?

  • Donor—For BMT, anesthesia prevents pain during the procedure. You may have some pain or discomfort in the area where the bone marrow was removed, but pain medication may be given to relieve pain and soreness during recovery. For PBSC, the needle sticks cause a small amount of pain.
  • Recipient—You won't feel any pain while the stem cells are infused. You may have some nausea, which can be treated with medication.

Possible Complications

Donor

  • Bleeding
  • Infection

Recipient

  • Infection during the period when the original blood-forming cells in the bone marrow is being destroyed via chemotherapy and/or radiation, and before the donor blood-forming cells multiply and then begin to function
  • Rejection of donor blood-forming cells (stem cells)
  • Acute graft versus host disease, which occurs when the immune cells in the donor's bone marrow attack the recipient's tissues

Average Hospital Stay

  • Donor—Overnight if BMT. Several donations, each lasting a couple of hours, if PBSC.
  • Recipient—1-2 months

Postoperative Care

Donor

  • Pain medication and antibiotics to prevent infection

Recipient

  • Immunosuppressant medications 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 monitor whether the new stem cells in the bone marrow is taking hold or being rejected

Outcome

It may take about a month for the donor stem cells in the bone marrow to begin functioning fully within the recipient. If the transplant is successful, diseased cells will have been removed during pretreatment with chemotherapy and/or radiation, and new bone marrow cells will produce healthy red blood cells, white blood cells, and platelets.

Call Your Doctor If Any of the Following Occurs

  • Nausea and/or vomiting
  • Severe pain
  • New onset of pain more than 24 hours after the procedure has been completed
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the needle insertion site
  • Signs of infection, including fever and chills
  • Rash
  • Diarrhea

RESOURCES:

BMT InfoNet (Blood & Marrow Transplant Information Network)
http://www.bmtinfonet.org

National Marrow Donor Program
http://www.marrow.org

CANADIAN RESOURCES:

Canadian Association of Transplantation (CAT)
http://www.transplant.ca

Canadian Blood Services
http://www.bloodservices.ca/

References:

Merck Manual OnLine . Merck & Co., Inc.; 2000.

Questions and answers. National Cancer Institute, National Institutes of Health Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation website. Available at: http://www.cancer.gov/cancertopics/factsheet/Therapy/bone-marrow-transplant .



Last reviewed March 2008 by Igor Puzanov, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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