A stem cell or bone marrow transplant replaces damaged blood cells with healthy ones. It can be used to treat conditions affecting the blood cells, such as leukaemia and lymphoma.
Stem cells are special cells produced by bone marrow (a spongy tissue found in the centre of some bones) that can turn into different types of blood cells.
The 3 main types of blood cell they can become are
red blood cells – which carry oxygen around the body
white blood cells – which help fight infection
platelets – which help stop bleeding
A stem cell transplant involves destroying any unhealthy blood cells and replacing them with stem cells removed from the blood or bone marrow.
Why are stem cell transplants carried out?
Stem cell transplants are used to treat conditions in which the bone marrow is damaged and is no longer able to produce healthy blood cells.
Transplants can also be carried out to replace blood cells that are damaged or destroyed as a result of intensive cancer treatment.
Conditions that stem cell transplants can be used to treat include
severe aplastic anaemia (bone marrow failure)
leukaemia – a type of cancer affecting white blood cells
lymphoma – another type of cancer affecting white blood cells
multiple myeloma – cancer affecting cells called plasma cells
certain blood, immune system and metabolic disorders – including sickle cell anaemia, thalassaemia, severe combined immunodeficiency (SCID) and Hurler syndrome
A stem cell transplant will usually only be carried out if other treatments have not helped, the potential benefits of a transplant outweigh the risks and you''re in relatively good health, despite your underlying condition.
What does a stem cell transplant involve?
A stem cell transplant can involve taking healthy stem cells from the blood or bone marrow of one person – ideally a close family member with the same or similar tissue type – and transferring them to another person. This is called an allogeneic transplant.
It''s also possible to remove stem cells from your own body and transplant them later, after any damaged or diseased cells have been removed. This is called an autologous transplant.
A stem cell transplant has 5 main stages. These are
Tests and examinations – to assess your general level of health.
Harvesting – the process of collecting the stem cells to be used in the transplant, either from you or a donor.
Conditioning – treatment with chemotherapy and/or radiotherapy to prepare your body for the transplant.
Transplanting the stem cells.
Recovery – you''ll need to stay in hospital for at least a few weeks until the transplant starts to take effect.
Having a stem cell transplant can be an intensive and challenging experience. You''ll usually need to stay in hospital for at least a few weeks until the transplant starts to take effect and it can take up to a year or longer to fully recover.
Read more about what happens during a stem cell transplant.
Risks of a stem cell transplant
Stem cell transplants are complicated procedures with significant risks. It''s important that you''re aware of both the risks and possible benefits before treatment begins.
Possible problems you can have during or after the transplant process include
graft versus host disease (GvHD) – this happens in allogeneic transplants when the transplanted cells start to attack the other cells in your body
reduced number of blood cells – this can lead to iron deficiency anaemia, excessive bleeding or bruising, and an increased risk of infections
chemotherapy side effects – including sickness, tiredness, hair loss and infertility
Read more about the risks of having a stem cell transplant.
Stem cell donation
If it is not possible to use your own stem cells for the transplant, stem cells will need to come from a donor.
To improve the chances of the transplant being successful, donated stem cells need to carry a special genetic marker – known as a human leukocyte antigen (HLA) – that''s identical or very similar to that of the person receiving the transplant.
The best chance of getting a match is from a brother or sister, or sometimes another close family member. If there are no matches in your close family, a search of the British Bone Marrow Registry will be carried out.
Most people will eventually find a donor in the registry, although a small number of people may find it very hard or impossible to find a suitable match.
A stem cell or bone marrow transplant is a long and complicated process that involves 5 main stages.
These stages are
Tests and examinations – to assess your general level of health.
Harvesting – the process of collecting the stem cells to be used in the transplant, either from you or a donor.
Conditioning – treatment to prepare your body for the transplant.
Transplanting the stem cells.
Recovery – you''ll need to stay in hospital for at least a few weeks until the transplant starts to take effect.
Tests and examinations
Before a stem cell transplant can be carried out, you''ll need a series of tests and examinations to ensure you''re healthy enough for the procedure to be carried out.
Transplants tend to be more successful in people who are in good general health, despite their underlying condition.
The tests you might have include
an electrocardiogram (ECG) – a simple test used to check your heart''s rhythm and electrical activity
an echocardiogram – a scan used to look at the heart and nearby blood vessels
an X-ray and/or computerised tomography (CT) scan to check the condition of organs such as the lungs and liver
blood tests to check the level of blood cells and assess how well the liver and kidneys are working
If you have cancer, you may also need to have a biopsy. This is where a small sample of cancerous cells is removed and analysed. It can show whether your cancer is under control (in remission) and whether there''s a high risk of it returning after your transplant.
Harvesting stem cells
After you''ve had tests to check your general health, the stem cells that will be used for the transplant need to be removed and stored.
There are 3 main ways stem cells can be harvested. These are
from blood – where the stem cells are removed from the blood using a special machine
from bone marrow – where a procedure is carried out to remove a sample of bone marrow from the hip bone
from cord blood – where donated blood from the placenta and umbilical cord of a newborn baby is used as the source of stem cells (find out more about cord blood on the NHS Blood and Transplant website)
It may be possible to remove stem cells from your own blood or bone marrow and transplant them later after any damaged or cancerous cells have been removed.
If this is not possible, stem cells from a donor''s blood or bone marrow will usually be used.
Removing stem cells from blood
The most common way to harvest stem cells involves temporarily removing blood from the body, separating out the stem cells, and then returning the blood to the body.
To boost the number of stem cells in the blood, medicine that stimulates their production will be given for about 4 days beforehand. On the 5th day, a blood test will be carried out to check there are enough circulating stem cells.
If there are enough cells, veins in each arm will be connected by tubes to a cell separator machine. Blood is removed from one arm and passed through a filter, before being returned to the body through the other arm.
This procedure is not painful and is done while you''re awake. It takes around 3 to 4 hours and may need to be repeated the next day if not enough cells are removed the first time.
Removing a bone marrow sample
An native method of collecting stem cells is to remove around a litre of bone marrow from your hip bone using a needle and syringe.
The needle may need to be ed into several parts of your hip to ensure enough bone marrow is obtained. This is done under a general anaesthetic, so you''ll be asleep and will not feel any pain while it''s carried out.
However, the area where the needle is ed may be painful afterwards and you''ll have marks on your skin where it was ed (usually one on each side).
Conditioning treatment
Treatment with high doses of chemotherapy and sometimes radiotherapy will be needed before the stem cells can be transplanted.
This is to
destroy existing bone marrow cells – to make room for the transplanted tissue
destroy any existing cancer cells
stop your immune system working – this reduces the risk of the transplant being rejected
As part of the conditioning treatment, you''ll be given a range of medicines, so a tube called a central line will usually be ed into a large vein near your heart. This means medicine can be passed into your body without the need for lots of injections.
The conditioning process usually lasts about a week or 2. You''ll probably need to stay in hospital throughout the treatment.
Conditioning can cause a number of unpleasant side effects, such as sickness, hair loss and tiredness. These are usually temporary. Your treatment team will discuss the risks of treatment with you beforehand.
Read more about the risks of stem cell transplants.
The transplant
The transplant will usually be carried out a day or 2 after conditioning has finished.
The stem cells will be passed slowly into your body through the central line. This process often takes around a couple of hours.
The transplant will not be painful and you''ll be awake throughout.
Recovery
Once the transplant is finished, you''ll need to stay in hospital for a few weeks while you wait for the stem cells to settle in your bone marrow and start producing new blood cells.
During this period you may
feel weak, and you may experience diarrhoea and vomiting, and/or a loss of appetite
be given fluids by mouth or through a tube running from your nose to your stomach (a nasogastric tube) to prevent malnutrition
have regular blood transfusions, as you''ll have a low number of red blood cells
have regular platelet transfusions, as you''ll have a low number of platelets
stay in a special germ-free room, and visitors may need to wear protective clothing to prevent infections, as you''ll have a low number of infection-fighting white blood cells
Many people are well enough to leave hospital between 1 and 3 months after the transplant. However, if you develop complications such as an infection, you may have to stay in hospital for longer.
Even after going home, you''ll still be at risk of infections for potentially a year or longer because it can take a while for your immune system to return to full strength.
If donated stem cells were transplanted, you''ll also usually need to take medicines called immunosuppressants that stop your immune system from working so strongly. This is to reduce the risk of your body attacking the transplanted cells or to reduce the risk of the transplanted cells attacking other cells in your body.
Stem cell or bone marrow transplants are complex treatments that carry a significant risk of serious complications.
It''s important that you''re aware of both the risks and possible benefits before treatment begins. You may wish to discuss them with your treatment team and your family.
Generally speaking, younger people who do not have any other serious conditions or those who receive transplants from a closely matched sibling are less likely to experience serious problems. People receiving transplants of their own stem cells (autologous transplants) are also less likely to experience serious side effects.
Graft versus host disease (GvHD)
Sometimes, the transplanted cells recognise the recipient''s cells as "foreign" and attack them. This is known as graft versus host disease (GvHD).
GvHD can happen within a few months of the transplant or develop several months, or occasionally a year or 2, la
