Stem Cell Transplants - What They Are and What They Do

by Jane Ashley

A stem cell transplant is a treatment for blood cancers. It’s used to treat certain types of leukemia, some kinds of lymphoma and to treat multiple myeloma.

Northside Hospital Bone Marrow Transplant Unit

It used to be referred to as a bone marrow transplant because the stem cells were extracted from the bone marrow. Now, stem cells are harvested from the blood so they are referred to as stem cell transplants. But they are the same medical procedure, regardless of which terminology is used.

Who needs a stem cell transplant?

Stem cell transplants are usually used for patients if they suffer from one of these three situations. Stem cells are called “hematopoietic” and can turn into any type of blood cell. They are found in the bone marrow and in our circulating blood.

• Catastrophic failure of the bone marrow or stem cells so that they can’t make blood cells
• Your bone marrow or blood cells become diseased to the point that your survival is at risk
• You can only be cured with high doses of strong chemotherapy and/or radiation that would kill your stem cells as well as your cancer
Stem cell transplants are utilized most often in the treatment of cancer of these cancers.
• Acute lymphoblastic leukemia (ALL)
• Acute myeloid leukemia (AML)
• Chronic lymphocytic leukemia (CLL)
• Chronic myelogenous leukemia (CML)
• Hodgkin lymphoma
• Non-Hodgkin lymphoma
• Multiple myeloma
• Myelodysplastic syndrome
• Waldenström's macroglobulinemia
• Myeloproliferative disorders (polycythemia, myelofibrosis, and thrombocythemia)
• Testicular cancer

Both adults and children receive life-saving stem cell transplants.

Stem cell transplants are not usually the first line of treatment because although they can cure cancer, they carry significant risks and are costly, ranging from $350,000 to $800,000.

The Two Types of Stem Cell Transplants

Stem Cell Transplant

There are two main types of stem cells transplants.

Autologous transplant aka Auto Transplant. This is when a patient receives their own stem cells after they get treated for their cancer. A patient’s own healthy stem cells are collected through a process known as apheresis. The medical facility freezes the stem cells to use after treatment. Treatment consists of potent chemotherapy and, occasionally, radiation. Then, the patient’s stem cells are thawed and infused back into the patient via an IV. Within 24 hours, the newly infused stem cells are in the patient’s bone marrow where they begin to grow, multiply and help the bone marrow make new, healthy blood cells.
Allogeneic transplantation aka ALLO transplant. For this type of stem cell transplant, the patient gets another person’s healthy stem cells. This requires that the donor’s marrow matches the patient’s bone marrow. White blood cells contain a protein called human leukocyte antigens (HLA). The closest match helps prevent a serious condition known as graft-versus-host disease (GVHD) where healthy cells from the transplant attack the patient’s own healthy cells. Matches may come from a brother or sister or other family member. Some patients may not have siblings or other family members still alive — that’s when the National Marrow Donor Program comes into play. They maintain a registry of over 33 million potential donors and over 765,000 units of umbilical cord blood units to help critically ill cancer patients find a match for a life-saving stem cell transplant. Once a donor is found, the patient receives strong chemotherapy and/or radiation. Typically, the stem cells are not frozen, and the patient receives the new stem cells immediately after treatment.

Which type of stem cell transplant a patient receives is dependent on the type of cancer and if your bone marrow is still healthy. If your cancer is in your bone marrow, you’ll have to receive donor marrow to replace your diseased bone marrow.

Decision Time

Your cancer treatment team evaluates each potential patient’s options and makes the recommendation to have a stem cell transplant. The pros and cons are evaluated to determine if a stem cell transplant is the best option for you. Considerations include:

• Age
• Stage of cancer
• Time already spent in treatment
• Donor source
• Patient’s overall health

Once the decision is made, patients and their family have many other decisions to make. A stem cell transplant is complicated. There are over 200 stem cells transplant centers in the U.S. Patients and family members have to travel so there are logistical and financial considerations in addition to looking at the centers that have the best success rates. The patient also has insurance considerations. Here’s are some of the factors you’ll need to consider.

• How much will your insurance cover?
• How much out of pocket will you have to pay?
• Who will take care of you during treatment?
• How long will you be away from home?
• How long will you be in the hospital?
• Where will your caregiver stay while you are in the hospital?
• Who will take you back and forth to appointments?
• What kind of follow-up care will you need?
• Will you be able to return to work afterward?

Bone Marrow Detail

Fortunately, organizations like The National for Transplants (NFT), BeTheMatch and The Bone Marrow and Cancer Foundation have trained team members to help you through every step of your stem cell transplant. Some larger insurance companies have transplant case managers. 

You won’t be alone.

If you or a loved one may be facing a stem cell transplant, download this comprehensive 60-page brochure to learn more about stem cell transplants.

WhatNext?

Approximately 23,000 stem cell transplants are performed annually in the United States. Almost 60 percent are the autologous type (from the patient’s own stem cells) and the remaining are from donors — about 40 percent of those are from related donors and the remaining 60 percent are from unrelated donors.

How can we help? We, as cancer patients can’t be donors. But our family members and friends can sign up to be donors. There is a need for more donors in certain ethnic groups:

• African-American
• Alaskan Natives
• American Indian
• Asian
• Bi-racial individuals
• Hispanic or Latino
• Native Hawaiian
• Pacific Islanders

There is also a need for umbilical cord donors. This source of stem cells can be used when a donor match isn’t available or when there is an immediate need for a match. If a daughter or granddaughter is pregnant in your family and wants to help fight cancer, tell her about the need for umbilical cord blood.

Stem cell transplants, although still relatively uncommon, save lives.

Have you had a Stem cell Transplant? Please share your experiences in the comments. 

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