You go into hospital about a week before a donor stem cell transplant to start conditioning treatment. Conditioning means having treatments to get your body ready for your donor's cells.
You will usually be looked after in a room of your own but this can depend on the unit you are in. You will be staying in your room for at least a few weeks, so you might want to take some things from home. We have more information about getting ready to go into hospital.
Visitors, especially close family and friends and your partner, if you have one, are important. Some units have rooms where family members can stay overnight. This is useful if your relatives have to travel to hospital.
If you have a family or a partner who want to stay nearby, your specialist nurse can give you advice about getting financial help.
Most hospitals are flexible about visiting, but different hospitals have different rules. You may be restricted to a certain number of visitors each day to help protect you from infection. The nurses will explain more about this to you.
You may have conditioning treatment to:
- get your body ready to accept the donor stem cells
- weaken your immune system to reduce the risk of it attacking the donor stem cells
- remove any remaining cancer or leukaemia cells from your body.
Conditioning can take up to 2 weeks. It usually involves having several different chemotherapy drugs. Some people also have radiotherapy to the whole body, called total body irradiation (TBI). You may also be given antibody therapy.
During conditioning treatment, your doctors may talk about days as numbers. The day of your transplant (stem cell infusion) is Day 0. The days before transplant are counted as Day –8, Day –7, and so on. The days after transplant are counted as Day +1, Day +2, and so on.
You usually finish conditioning treatment 24 to 48 hours before the transplant (Day –2 or Day –1).
Types of conditioning treatment
There are different types of conditioning treatment and different levels of intensity (strength) of treatment. Your conditioning treatment depends on the type of cancer or leukaemia you have and your general health. Doctors will also consider any chemotherapy or radiotherapy that you have had in the past.
- Full-intensity conditioning
You have very high-doses of chemotherapy, sometimes with total body irradiation (TBI) to destroy your bone marrow and immune system. This is to prepare you for having the donor stem cells.
- Reduced-intensity conditioning
You have fewer or lower doses of chemotherapy or radiotherapy, which should reduce the risk of transplant complications. But it weakens your immune system enough to allow the donor stem cells to grow in your bone marrow. When both your donor’s cells and your own cells are in your system, this is called mixed chimerism. The donor stem cells will gradually replace your immune system and attack any remaining cancer cells in your body.
Conditioning with chemotherapy
The chemotherapy drugs are given through your central line or PICC line with plenty of fluids. The treatment is usually given over several days. Chemotherapy can cause side effects. Your doctor and nurse will explain how these can be managed. You will be given drugs to help control certain side effects.
Conditioning with total body irradiation
Radiotherapy uses high-energy rays to destroy cancer cells. TBI treats your whole body with radiotherapy and some people have it as part of their conditioning treatment. You usually have it a few days after you start chemotherapy.
You may have TBI twice a day for 6 to 8 sessions over 3 to 4 days. If you are having reduced-intensity conditioning, you may only need one or two low doses of TBI or none at all.
You will have a planning session in the radiotherapy department a few days before you have TBI. The doctor will explain more about the treatment and its side effects.
Before each session, the radiographer (person who gives the treatment) positions you carefully and makes sure you are comfortable. Radiotherapy is not painful, but you need to keep still during the treatment. You have radiotherapy to both sides of your body so you need to change position a few times during the session. The radiographer will explain this to you.
During treatment, you are alone in the room but you can talk to the radiographer through an intercom. Each session lasts about 40 minutes, but the radiotherapy itself only takes about 10 to 20 minutes. You can bring some CDs to listen to during your treatment.
Side effects of TBI
Possible side effects of TBI include skin changes, tiredness, feeling sick, diarrhoea and a sore mouth. These can happen a few days later. The radiographers will explain how to manage the side effects and how to care for your skin.
We have more information about radiotherapy side effects.
Antibody therapy as part of conditioning treatment
You may be given a type of targeted therapy antibody drug to help damage your immune system. This is to allow the donor cells to grow and make new blood cells. The drug may also reduce the risk of graft-versus-host disease (GVHD).
You have the antibody drug given as a drip. Some people may have a reaction to it, which can sometimes be severe. You may have a fever and sometimes shivering (rigors). You will be given drugs to try to prevent or reduce a reaction before you have the antibody therapy. The nurses will monitor you closely.
You may also get an itchy rash that is sometimes raised on the skin.
If your donor is a relative, their stem cells are collected the day before the transplant. If your donor is not related, their stem cells are collected 2 days before the transplant. this is to make sure you are ready for the transplant soon after the stem cells are available.
Your donor’s stem cells can be collected either from their blood or, less commonly, from their bone marrow.
We have more information about how the donor’s stem cells are collected.
You have your transplant of donor stem cells a day or two after finishing conditioning treatment. The transplant day is known as Day 0.
Some people have mild side effects while the stem cells are being given, such as feeling sick or breathless. Your nurse will give you drugs through your central line before the stem cell infusion to reduce the risk of an allergic reaction. They monitor you carefully during and after the stem cell infusion.
For some people, having the stem cells may be an emotional experience. But it may also seem like any other day in hospital. There is no right or wrong way or to feel about it.
The stem cells travel through your blood to your bone marrow, where they start growing and making new blood cells. Doctors call this engraftment.
Until your donated cells start making new blood cells, you will have low numbers of all types of blood cells. This causes some of the main transplant side effects. You will have a high risk of getting an infection, of bleeding and of being anaemic (low red cells). While you are waiting for the donor cells to make new blood cells, your transplant team will care for you and monitor you very closely for complications.
It can be from 10 days to 3 weeks before some of the new blood cells are released into the blood. If you had a cord blood transplant or a haploidentical transplant it can take longer than this.
You may be given a drug called a growth factor as an injection. It stimulates your bone marrow to make new blood cells and reduces the length of time you are at risk of side effects.
Your daily routine
Although you may expect to have a lot of free time, your days may be quite busy with daily routines and checks by the doctors and nurses. They will:
- take blood samples from your line
- give medicines into your line
- change your drip (infusion) of fluids when needed
- take your temperature, pulse and blood pressure
- examine your tummy and mouth
- measure the fluid you take in and the fluid you pass out (fluid balance)
- check your weight.
You will also be seen regularly by the dietitian, physiotherapist and other members of the team looking after you.
When your blood counts have reached a safe level, your transplant team will talk to you about going home. Before you go home you will need to:
- have recovered enough from all your side effects
- be eating and drinking well
- be walking about by yourself
- be able to take your tablets so you don't need drugs through your line.
You can usually have your central line removed when you leave hospital.
You may feel impatient to go home but anxious about leaving the support of the hospital. It can take time to adjust after spending so long in hospital. If you live on your own, you will need to arrange for a relative, friend or partner to stay with you. Or the hospital staff can arrange support from carers when you go home.
Because there are still some things you can't do, it may seem as though you will never get back to normal life again. As you recover, you will find that things gradually shift away from the treatment and back to day-to-day living. We have more information about recovering from treatment.