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INFORMATION FOR PATIENTS AND DONORS
Autologous Blood Stem Cell Transplantation
What is autologous blood stem cell transplantation?
In autologous blood stem cell transplantation (APBSCT), stem cells are collected from the bloodstream and stored for use later in patients treated with high doses of chemotherapy. The goal is to transplant healthy stem cells after high doses of chemotherapy. The healthy stem cells can restore the bone marrow's ability to produce healthy blood cells.
What are stem cells?
Stem cells are immature, or baby, cells that live in your bone marrow. Bone marrow is the spongy tissue in the center of bones. Most stem cells live in the bone marrow, but some are also found in the bloodstream. These cells grow up to become blood cells that flow through our bodies. Blood cells help your body in many ways. For example:
Chemotherapy cannot tell the difference between normal cells and cancer cells; therefore, higher doses of chemotherapy can damage bone marrow. Stem cells are removed from the bloodstream and stored before high doses of chemotherapy are given. This process is known as apheresis, a procedure similar to donating platelets at the blood bank. You are given medication to help increase the number of stem cells and move them into your bloodstream. Blood is removed through a flexible tube that is placed in a large vein in your chest area (central venous catheter). The blood goes through a machine that separates and removes stem cells. The rest of your blood is returned to you. The apheresis process takes about 4 to 5 hours a day. Enough stem cells can usually be collected in 1 to 2 days. The collected cells are then frozen and stored for later use.
When do I start high-dose chemotherapy?
Some cancers may not respond well to normal doses of chemotherapy or they may come back after regular chemotherapy treatments. In these cases, higher doses of chemotherapy may be required to treat these cancers.
After enough stem cells have been collected, you will be ready for high-dose chemotherapy. The chemotherapy drugs used will vary depending on the type of cancer you have. You may be given a single drug on one day or multiple drugs over several days. You may need to be hospitalized for several weeks to receive this therapy. It is also possible to perform this treatment as an outpatient. You and your transplant doctor will decide on the best approach for you.
When are my stem cells returned to my bloodstream?
A day or two after the high-dose chemotherapy is completed, you will be given back your stem cells. The frozen stem cells are brought to your bedside, thawed in a warm water bath, and reinfused through your central venous catheter. This is a quick process. It usually takes about 5 minutes to infuse a bag of stem cells. The number of bags infused depends on the number of days for apheresis.
After your stem cell transplantation
The recovery period begins after your stem cells have been reinfused. During this time, you are most at risk for infection, bleeding, and needing blood transfusions. It may take 1 to 2 weeks for your stem cells to travel back to the bone marrow and make new blood cells. Once your blood count has returns to normal, inpatients may be discharged from the hospital and follow up in the transplantation clinic. You will return to the clinic 2 to 3 times a week. These visits will decrease based on how quickly you recover and an individual followup schedule will be determined for you.
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Allogeneic Blood Stem Cell Transplantation
What is allogeneic blood stem cell transplantation?
In an allogeneic transplantation, stem cells or bone marrow from a healthy donor are given to a patient who has received high-dose chemotherapy. In the past, bone marrow was used for these transplantations because it has large amounts of stem cells. Now more donors are having their blood stem cells collected for donation. This process is called apheresis. Donors are given a special medication to make their bone marrow release stem cells into the bloodstream. Blood cells are collected from a large vein in the donor's arm. The blood is run through a machine that separates the stem cells and the remaining blood is returned to the donor.
Why have allogenic blood stem cell transplantation?
In some diseases such as leukemia, aplastic anemia, and diseases of the immune system, blood cell production in the bone marrow is affected. Your bone marrow can make too few blood cells or it may produce too many abnormal cells. Abnormal cells can crowd out the good cells. This can cause your body not to have enough white blood cells, red blood cells, and platelets.
High doses of chemotherapy, radiation therapy, or both may be used to kill the abnormal cells in the bone marrow. This makes room for the donor's stem cells. The donor's stem cells should develop into healthy blood cells.
How is a donor found?
People have different proteins called HLA (human leukocyte antigens). These markers help the body recognize self from non-self. Potential donors will need to undergo HLA typing to see how closely their tissue matches yours. This is done by performing a simple blood test.
The closest tissue or HLA match is important to prevent serious complications post-transplantation. As a result, it is necessary to find someone who is the closest tissue match to you. This would most likely be a full brother or sister if you have one. If not, the transplantation center will start looking through national bone marrow registries for a potential matched unrelated donor.
When do I start high-dose chemotherapy?
Once a donor has been identified and the collection of donor stem cells is complete, you will be ready for high-dose chemotherapy. The chemotherapy drugs will vary based upon the type of cancer you have. You will also have central venous catheter placed. This is a flexible tube that is placed in a large vein in your chest area. Chemotherapy, IV fluids, and your donor cells are given through this line. Expect to be hospitalized for this procedure. Average length of hospitalization may be 3 to 4 weeks to allow for recovery.
When are the donor stem cells infused to my bloodstream?
A day or two after high-dose chemotherapy is complete, you will be given the donor stem cells. The frozen cells are brought to your bedside, thawed in a warm bath, and reinfused through your central venous catheter. This is a quick process. It usually takes about 5 minutes to infuse a bag of stem cells.
After transplantation
The recovery period begins after your stem cells have been infused. It may take 2 to 3 weeks for the stem cells to travel back to the bone marrow and make new blood cells. During this time, you are most at risk for infection, bleeding, needing blood transfusions, and developing graft-versus-host disease (GVHD). Once your blood count has returned to normal, you may be discharged from the hospital and followed up in the transplantation clinic. You will return to the clinic 2 to 3 times a week. These visits are less frequent in later weeks. A follow up schedule will be determined for you.
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Graft-versus-Host Disease
What is graft-versus-host disease?
Graft-versus-host disease (GVHD) can be a potential problem following allogeneic transplantation (transplant using donor marrow or donor peripheral blood stem cells). There is a chance that the new donor cells (the graft) will think your organs and tissues (the host) are foreign cells. If this happens, the donor's cells injure your tissues and cells. In a small percentage of cases, GVHD can become quite severe and even life threatening.
Is anyone more at risk for getting GVHD?
Both donor and recipient are HLA (human leukocyte antigen) typed prior to transplantation. This is a simple blood test to determine a tissue match between the patient and donor. GVHD is less likely to develop if the donor is a close HLA match to the patient. Other factors that increase your chances of getting GVHD are as follows:
There are two types of GVHD: acute and chronic. They differ by the time of onset and clinical signs and symptoms. You may develop either kind, both, or neither.
Acute GVHD
Acute GVHD generally occurs during the first three months after transplantation. The first sign is usually a mild skin rash. In severe cases, the skin may blister or peel. Acute GVHD can also affect the stomach and intestines causing nausea, cramping, and watery or bloody diarrhea. Liver injury can also occur. When this happens, patients may notice yellowing of the skin.
Your transplant doctor will prescribe special medications to prevent and treat acute GVHD. These drugs work to decrease the chance of a reaction by your new immune system. The immune system normally helps to fight infections. Using these medications, most patients do not get serious GVHD.
Chronic GVHD
Chronic GVHD can occur 3 months to 2 years after transplantation. Patients who have had acute GVHD are more at risk for getting chronic GVHD. With chronic GVHD, you may have a dry, itchy rash, change in skin color and texture, stomach problems, dry or burning eyes, dry mouth or nose, and hair loss.
Most patients are placed on steroids if chronic GVHD develops. Your transplant doctor will look at your signs and symptoms to determine the best treatment plan for you.
If I get GVHD, has my transplant failed?
Although some form of GVHD may occur after transplantation, this does not mean that your transplant has failed. Studies have shown that mild forms of GVHD may be of benefit. This is because the donor cells may also attack any stray cancer cells remaining after high-dose chemotherapy. Research is still ongoing to find new ways to prevent and manage GVHD.
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Prepared by: Kelly Gray, RN, BSN, ONS
UT Blood and Marrow Transplant Center
August 2003
 Auto BMT from The Bone Marrow Foundation |
 Allo BMT from The Bone Marrow Foundation |
 Blood Stem Cell Donation from the NMDP |
Autologous Blood Stem Cell Transplantation
What is autologous blood stem cell transplantation?
In autologous blood stem cell transplantation (APBSCT), stem cells are collected from the bloodstream and stored for use later in patients treated with high doses of chemotherapy. The goal is to transplant healthy stem cells after high doses of chemotherapy. The healthy stem cells can restore the bone marrow's ability to produce healthy blood cells.
What are stem cells?
Stem cells are immature, or baby, cells that live in your bone marrow. Bone marrow is the spongy tissue in the center of bones. Most stem cells live in the bone marrow, but some are also found in the bloodstream. These cells grow up to become blood cells that flow through our bodies. Blood cells help your body in many ways. For example:
- White blood cells help fight infection.
- Red blood cells help carry oxygen to your organs and tissues.
- Platelets help clot blood to prevent bleeding.
Chemotherapy cannot tell the difference between normal cells and cancer cells; therefore, higher doses of chemotherapy can damage bone marrow. Stem cells are removed from the bloodstream and stored before high doses of chemotherapy are given. This process is known as apheresis, a procedure similar to donating platelets at the blood bank. You are given medication to help increase the number of stem cells and move them into your bloodstream. Blood is removed through a flexible tube that is placed in a large vein in your chest area (central venous catheter). The blood goes through a machine that separates and removes stem cells. The rest of your blood is returned to you. The apheresis process takes about 4 to 5 hours a day. Enough stem cells can usually be collected in 1 to 2 days. The collected cells are then frozen and stored for later use.
When do I start high-dose chemotherapy?
Some cancers may not respond well to normal doses of chemotherapy or they may come back after regular chemotherapy treatments. In these cases, higher doses of chemotherapy may be required to treat these cancers.
After enough stem cells have been collected, you will be ready for high-dose chemotherapy. The chemotherapy drugs used will vary depending on the type of cancer you have. You may be given a single drug on one day or multiple drugs over several days. You may need to be hospitalized for several weeks to receive this therapy. It is also possible to perform this treatment as an outpatient. You and your transplant doctor will decide on the best approach for you.
When are my stem cells returned to my bloodstream?
A day or two after the high-dose chemotherapy is completed, you will be given back your stem cells. The frozen stem cells are brought to your bedside, thawed in a warm water bath, and reinfused through your central venous catheter. This is a quick process. It usually takes about 5 minutes to infuse a bag of stem cells. The number of bags infused depends on the number of days for apheresis.
After your stem cell transplantation
The recovery period begins after your stem cells have been reinfused. During this time, you are most at risk for infection, bleeding, and needing blood transfusions. It may take 1 to 2 weeks for your stem cells to travel back to the bone marrow and make new blood cells. Once your blood count has returns to normal, inpatients may be discharged from the hospital and follow up in the transplantation clinic. You will return to the clinic 2 to 3 times a week. These visits will decrease based on how quickly you recover and an individual followup schedule will be determined for you.
Back to Top
Allogeneic Blood Stem Cell Transplantation
What is allogeneic blood stem cell transplantation?
In an allogeneic transplantation, stem cells or bone marrow from a healthy donor are given to a patient who has received high-dose chemotherapy. In the past, bone marrow was used for these transplantations because it has large amounts of stem cells. Now more donors are having their blood stem cells collected for donation. This process is called apheresis. Donors are given a special medication to make their bone marrow release stem cells into the bloodstream. Blood cells are collected from a large vein in the donor's arm. The blood is run through a machine that separates the stem cells and the remaining blood is returned to the donor.
Why have allogenic blood stem cell transplantation?
In some diseases such as leukemia, aplastic anemia, and diseases of the immune system, blood cell production in the bone marrow is affected. Your bone marrow can make too few blood cells or it may produce too many abnormal cells. Abnormal cells can crowd out the good cells. This can cause your body not to have enough white blood cells, red blood cells, and platelets.
High doses of chemotherapy, radiation therapy, or both may be used to kill the abnormal cells in the bone marrow. This makes room for the donor's stem cells. The donor's stem cells should develop into healthy blood cells.
How is a donor found?
People have different proteins called HLA (human leukocyte antigens). These markers help the body recognize self from non-self. Potential donors will need to undergo HLA typing to see how closely their tissue matches yours. This is done by performing a simple blood test.
The closest tissue or HLA match is important to prevent serious complications post-transplantation. As a result, it is necessary to find someone who is the closest tissue match to you. This would most likely be a full brother or sister if you have one. If not, the transplantation center will start looking through national bone marrow registries for a potential matched unrelated donor.
When do I start high-dose chemotherapy?
Once a donor has been identified and the collection of donor stem cells is complete, you will be ready for high-dose chemotherapy. The chemotherapy drugs will vary based upon the type of cancer you have. You will also have central venous catheter placed. This is a flexible tube that is placed in a large vein in your chest area. Chemotherapy, IV fluids, and your donor cells are given through this line. Expect to be hospitalized for this procedure. Average length of hospitalization may be 3 to 4 weeks to allow for recovery.
When are the donor stem cells infused to my bloodstream?
A day or two after high-dose chemotherapy is complete, you will be given the donor stem cells. The frozen cells are brought to your bedside, thawed in a warm bath, and reinfused through your central venous catheter. This is a quick process. It usually takes about 5 minutes to infuse a bag of stem cells.
After transplantation
The recovery period begins after your stem cells have been infused. It may take 2 to 3 weeks for the stem cells to travel back to the bone marrow and make new blood cells. During this time, you are most at risk for infection, bleeding, needing blood transfusions, and developing graft-versus-host disease (GVHD). Once your blood count has returned to normal, you may be discharged from the hospital and followed up in the transplantation clinic. You will return to the clinic 2 to 3 times a week. These visits are less frequent in later weeks. A follow up schedule will be determined for you.
Back to Top
Graft-versus-Host Disease
What is graft-versus-host disease?
Graft-versus-host disease (GVHD) can be a potential problem following allogeneic transplantation (transplant using donor marrow or donor peripheral blood stem cells). There is a chance that the new donor cells (the graft) will think your organs and tissues (the host) are foreign cells. If this happens, the donor's cells injure your tissues and cells. In a small percentage of cases, GVHD can become quite severe and even life threatening.
Is anyone more at risk for getting GVHD?
Both donor and recipient are HLA (human leukocyte antigen) typed prior to transplantation. This is a simple blood test to determine a tissue match between the patient and donor. GVHD is less likely to develop if the donor is a close HLA match to the patient. Other factors that increase your chances of getting GVHD are as follows:
- Unrelated donor (donor that is not a full brother or sister)
- Mismatched donor (donor that is not a complete match)
- Donors who have been pregnant.
There are two types of GVHD: acute and chronic. They differ by the time of onset and clinical signs and symptoms. You may develop either kind, both, or neither.
Acute GVHD
Acute GVHD generally occurs during the first three months after transplantation. The first sign is usually a mild skin rash. In severe cases, the skin may blister or peel. Acute GVHD can also affect the stomach and intestines causing nausea, cramping, and watery or bloody diarrhea. Liver injury can also occur. When this happens, patients may notice yellowing of the skin.
Your transplant doctor will prescribe special medications to prevent and treat acute GVHD. These drugs work to decrease the chance of a reaction by your new immune system. The immune system normally helps to fight infections. Using these medications, most patients do not get serious GVHD.
Chronic GVHD
Chronic GVHD can occur 3 months to 2 years after transplantation. Patients who have had acute GVHD are more at risk for getting chronic GVHD. With chronic GVHD, you may have a dry, itchy rash, change in skin color and texture, stomach problems, dry or burning eyes, dry mouth or nose, and hair loss.
Most patients are placed on steroids if chronic GVHD develops. Your transplant doctor will look at your signs and symptoms to determine the best treatment plan for you.
If I get GVHD, has my transplant failed?
Although some form of GVHD may occur after transplantation, this does not mean that your transplant has failed. Studies have shown that mild forms of GVHD may be of benefit. This is because the donor cells may also attack any stray cancer cells remaining after high-dose chemotherapy. Research is still ongoing to find new ways to prevent and manage GVHD.
Back to Top
Prepared by: Kelly Gray, RN, BSN, ONS
UT Blood and Marrow Transplant Center
August 2003