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Receiving a stem cell transplant
Stem cell transplants are usually done in 2 steps:
- conditioning or intensive therapy
- giving the stem cells (transplant)
Recipients are usually admitted to the hospital for conditioning or intensive therapy and stem cell transplant.
Conditioning or intensive therapy
The first step of the process may be referred to by different names, depending on the type of stem cell transplant. For an allogeneic or syngeneic transplant, the first step is usually called conditioning therapy or regimen (preparative therapy). For an autologous transplant, the first step is usually called intensive therapy.
Conditioning or intensive therapy is used to:
- prepare or “condition” the person’s bone marrow to accept donor stem cells before an allogeneic or syngeneic transplant
- remove any remaining cancer cells in the body before an autologous transplant
- destroy the bone marrow and make room for new stem cells
Conditioning or intensive therapy usually includes giving high doses of chemotherapy, sometimes followed by radiation therapy. These treatments vary depending on the disease being treated and the procedures of the transplant centre. The treatment is usually given over a few days.
Anticancer drugs are given into a vein (intravenously) through a central venous catheter (CVC).
The specific drugs depend on the disease being treated:
- Cyclophosphamide (Cytoxan, Procytox) or busulfan (Busulfex) are 2 drugs commonly given before stem cell transplant.
- Usually a combination of chemotherapy drugs is used.
High-energy rays are used to destroy cancer cells. Radiation therapy is given to the entire body. This is called total body irradiation (TBI).
The radiation therapy usually consists of 6 sessions:
- Each session may take about 20–30 minutes.
- Treatment may be given twice a day for 3 days or in one session over several hours.
Giving the stem cells (transplant)
The second step of the process is giving the stem cells (transplant). Stem cells are infused into the recipient’s blood. They eventually settle in the bone marrow, where they begin to multiply and mature.
- The transplant usually occurs 1–3 days after the end of conditioning or intensive therapy.
- Medicines are given before the stem cells are given (infused). These drugs help lessen side effects such as nausea, chills and fever.
- The stem cells are thawed and then given (infused) through a central venous catheter.
- The procedure can take about 1–2 hours. The length of time varies with the volume of stem cells being given.
- The number of stem cells given is calculated based on the recipient’s weight.
- During the infusion, the healthcare team monitors the recipient for side effects, such as chills, fever or hives, so that they can be promptly treated.
- If a preservative was mixed with the stem cells, the recipient will get a garlic taste in their mouth and may develop bad breath.
The day the stem cells are given is usually referred to as Day 0. The days after the transplant are numbered upward (for example, Day 1, Day 2). This system is used to describe the timing of events, such as when new blood cells begin to appear (engraftment) or when complications occur.