What's involved in a donor stem cell transplant
This section gives a brief explanation of what is involved in having a donor stem cell transplant.
Your specialist, nurse or transplant coordinator will explain why a donor stem cell transplant is advised and what the possible benefits and risks are.
Treatment is given to reduce the amount of leukaemia or cancer.
Stem cells are collected and stored until needed (this is called harvesting).
High-dose treatment is given to remove any remaining leukaemia or cancer cells (this is called conditioning).
The infusion of stem cells is given.
Your specialist or transplant coordinator will start to look for a suitable donor. They can start this process even if you haven’t made a final decision about having a transplant.
A suitable donor will be someone with a tissue type as close as possible to yours. If you have brothers and sisters (with the same parents) who are willing to be donors, they’ll be tested first. If you don’t have siblings or they aren’t a match, bone marrow registries are checked.
We have more information about what’s involved in donating stem cells.
Chemotherapy to treat the cancer (induction treatment)
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You’ll have treatment with chemotherapy, and possibly radiotherapy, to reduce the amount of leukaemia or cancer as much as possible. This is called induction treatment.
Ideally there shouldn’t be any signs of the cancer (this is called remission) at the time of the transplant. This gives the best possible chance for the treatment to work. In some situations though, a transplant may still be done if there’s a small amount of cancer present.
Collecting the donor’s stem cells
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The second step is the collection of the stem cells, which is known as the harvest. Stem cells may be collected from your donor towards the end of your conditioning treatment or collected in advance and frozen until they’re needed.
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You’ll have treatment to reduce the risk of your immune system rejecting and destroying the donor stem cells. This is known as conditioning treatment and usually lasts a few days. You may have chemotherapy alone or with radiotherapy.
Conditioning treatment may make you feel unwell, but you’ll be given drugs to help control side effects such as feeling sick (nausea) or being sick (vomiting). These drugs may make you feel sleepy.
Having the stem cell infusion
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After your conditioning treatment, you’ll be given the donor stem cells through a drip (infusion). This is a bit like having a blood transfusion.
The donor stem cells find their way from your blood to the bone marrow. They then ‘graft’ on to your marrow and start to make new blood cells for you. This is called ‘engraftment’. It usually takes 2-4 weeks.
You’ll needs lots of medical and nursing support until the numbers of blood cells reach a safe level. This may take several weeks. While the level of healthy blood cells is low, you may need antibiotics. This is because you’ll have very little resistance to infection.
You’ll probably be looked after in a room of your own to protect you from infection. You will also usually need to have blood and platelet transfusions.
Once the numbers of your blood cells have recovered to a certain level, you can leave hospital. You’ll still need careful monitoring, and you’ll have to go back to hospital for regular checks. The hospital staff will explain the things to watch out for and precautions that you’ll need to take until your new immune system is fully functioning.
Risks involved with a donor stem cell transplant
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A donor stem cell transplant is a complex and specialised treatment. It has many side effects and possible complications. You may need to stay in hospital for 4–6 weeks or longer, and for most of that time, you’ll usually be in a room of your own. There are likely to be times when you feel very unwell. It can take many months to fully recover, and some people may not get back to the same level of health they had before their transplant.
Your doctor will take into account your age and general health before advising you to have a donor stem cell transplant. There aren’t specific age limits, but for people over 65, the risks involved with donor stem cell transplant usually outweigh the benefits.
The main risks include:
Your doctor can tell you more about what these side effects may mean for you.
Unfortunately, infertility (being unable to have children) is usually a side effect of donor stem cell transplants. It’s important to talk to your specialist doctor or nurse about any concerns and options for preserving your fertility before treatment starts.
Questions you might like to ask your doctor
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What are the possible benefits of a donor stem cell transplant for me?
What are the risks?
Are there any long-term side effects?
How will it affect the way I live?
Will I be able to have children after the treatment?
How long will it be before I can start to live my normal life again?
What happens if the cancer comes back after my transplant?
You may also want to ask questions about what may happen if you decide not to have the transplant:
What other treatments can I have?
What’s likely to happen with my cancer?
Will I be able to go on with my normal life?
You’ll need to weigh up the possible benefits and risks of this treatment very carefully. A donor stem cell transplant may give a greater chance of curing the cancer or leukaemia, or getting it into remission, than any other treatment. This has to be weighed against the risks.
Although there have been many improvements in managing the side effects of a transplant, some people may die during or after the procedure. While this information can be upsetting to hear, your specialist needs to make sure that you’re fully aware of the possible benefits and risks. Your specialist will be able to tell you more about your situation.
You’ll need some time to think about your decision, and you may want to talk things over with your family and close friends. Most units have a nurse specialist, transplant coordinator, social worker or counsellor who you can also talk to.
Our section on making treatment decisions has information that might help you make your decision.
It’s a good idea to have someone else with you when talking to the hospital team. They can support you and help you with the information you’ve been given.
You don’t need to rush into making a decision about having a transplant. If you have questions, ask your hospital team. It’s important to have all the information you need before you make a decision.
Giving your consent
Before you have any treatment, your doctor will explain its aims. They’ll ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you’re asked to sign the form you should be given full information about:
the type and extent of the treatment
its advantages and disadvantages
any significant risks or side effects
any other treatments that may be available.
If you don’t understand what you’ve been told, let the staff know straight away, so they can explain it again. Having a transplant is a complex treatment, so it’s not unusual for people to need repeated explanations.
People sometimes feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.