Having a stem cell transplant

There are a few steps to get a stem cell transplant. Before the transplant, you will talk with the healthcare team about each of the steps and the effects of the transplant. A transplant is both physically and emotionally hard on you.

If a stem cell transplant is a treatment option, the doctor will examine you and do some tests to find out if a transplant will work for you.

The exams and tests may include:

• a complete health history and physical exam
• HLA testing
• a bone marrow biopsy
• a CT scan or an MRI
• an electrocardiogram (ECG) or echocardiogram (echo) or a wall motion study to check your heart
• a chest x-ray and pulmonary function tests to check your lungs
• blood tests such as complete blood count, blood chemistry tests and tests to check for viruses such as hepatitis, cytomegalovirus (CMV) and HIV

You may see other members of the healthcare team for:

• a dental exam and dental care
• a nutritional assessment
• a social work assessment
• a psychological and emotional evaluation
• fertility counselling

Once you have been told about all of the tests and procedures and agree to have a stem cell transplant, you will sign an informed consent form.

You will receive conditioning therapy, or intensive therapy, and the stem cell transplant either as an in-patient (you will stay overnight in the hospital) or an outpatient. The name of the therapy is based on the type of transplant. For an allogeneic or syngeneic transplant, it is usually called conditioning therapy or a conditioning regimen. For an autologous transplant, it is usually called intensive therapy.

Conditioning or intensive therapy is used to:

• make room in the bone marrow for the donor stem cells
• destroy any cancer cells still in the body
• suppress your immune system to lower the chance of rejecting the transplanted stem cells

Conditioning or intensive therapy usually includes giving high doses of chemotherapy through a central venous catheter (tube). It is sometimes followed by radiation therapy. These treatments vary depending on the disease being treated and the methods used at the transplant centre. The treatment is usually given over a few days.

Usually a combination of chemotherapy drugs is given. Radiation therapy is given to the entire body. This is called total body irradiation (TBI). TBI may be given in divided doses over a few days or in a single treatment.

The stem cells are given to you through a central venous catheter. They settle in the bone marrow and begin to multiply and mature. The day the stem cells are given is usually referred to as day 0.

The transplant is usually done 1 to 3 days after the end of conditioning or intensive therapy. Medicines are given before the transplant to help lessen your risk of side effects and reaction to the preservatives that are used when freezing the stem cells (in autologous transplants only).

If the stem cells were frozen, they are thawed in warm water and given to you. If the stem cells were not frozen, they may be removed in the operating room and processed in the lab then given to you right away.

The transplant can take about 1 to 2 hours. The length of time varies with the number of stem cells being given. The amount is calculated based on your weight.

When you are receiving the stem cells, the healthcare team will watch you closely for side effects. These effects may include chills, fever, chest pain, headache, nausea, shortness of breath and hives.

If the stem cells were frozen, you might get a garlic taste in your mouth from the preservative used. Your body will also have this odor. The taste and the odor will slowly fade over a few days.