Stem cell transplants | Cancer Research UK
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About stem cell transplants

Stem cell transplant is a treatment to try to cure some types of cancer, such as leukaemia, lymphoma and myeloma. You have very high doses of chemotherapy, sometimes with whole body radiotherapy. This has a good chance of killing the cancer cells but also kills the stem cells in the bone marrow. We need stem cells in order to make red blood cells, white blood cells and platelets. So after the high dose treatment you have stem cells into your vein through a drip. You may have your own stem cells or some from a donor.

Collecting the stem cells

You have injections of growth factors before, and sometimes after, the stem cell transplant. Growth factors are natural proteins that make the bone marrow produce blood cells. You have them as small injections under the skin for between 5 and 10 days. Sometimes you may have low doses of a chemotherapy drug too. The chemotherapy and growth factor injections help your bone marrow to make lots of stem cells. These stem cells then spill out of the bone marrow into the bloodstream, where they can be collected.

Collecting the stem cells takes 3 or 4 hours. You lie down on a couch. Your nurse puts a drip into each of your arms and attaches it to a machine. Your blood passes out of one drip, through the machine and back into your body through the other drip. The machine filters the stem cells out of your blood. The stem cells are frozen until you are ready to have them back. 

If you have stem cells from another person, you will have blood tests and the donor will also have blood tests. These tests make sure that the donated stem cells closely match your own.

Cord blood transplants use stem cells taken from the umbilical cord after a baby is born.

Mini transplants

Mini transplants are also called reduced intensity conditioning transplants. They use lower doses of chemotherapy than a traditional stem cell transplant. So they are used if people are too old or not well enough for a standard transplant.
 

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What stem cell transplants are

Stem cell transplant is a treatment to try to cure some types of cancer, such as leukaemia, lymphoma and myeloma. You have very high doses of chemotherapy, sometimes with whole body radiotherapy. This has a good chance of killing the cancer cells but also kills the stem cells in the bone marrow.

Stem cells are very early blood cells in the bone marrow that develop into red blood cells, white blood cells and platelets. We need stem cells in order to survive. So after the high dose treatment you have stem cells into a vein through a drip to replace those that the cancer treatment has killed.

Stem cell transplant means that you can have higher doses of treatment. So there may be more chance of curing the cancer than with standard chemotherapy.

 

Growth factors

You have injections of growth factors before, and sometimes after, the stem cell transplant. Growth factors are natural proteins that make the bone marrow produce blood cells. You have them as small injections under the skin.

You have daily injections of growth factor for between 5 and 10 days. Sometimes you may have low doses of a chemotherapy drug alongside the growth factor injections. The chemotherapy and growth factor injections help your bone marrow to make lots of stem cells. These stem cells then spill out of the bone marrow into the bloodstream. You have blood tests every day to see if there are enough stem cells in your bloodstream. When there are enough stem cells, your stem cells are collected (harvested).

Growth factor injections can cause some side effects. Some people have itching around the injection site. Some people get a high temperature (fever). You may have some pain in your bones after you have had a few injections. This is because there are a lot of blood cells being made inside the bones.

 

Collecting the stem cells

Collecting the stem cells takes 3 or 4 hours. You will be asked to lie down on a couch. Your nurse puts a drip into each of your arms and attaches it to a machine.

collecting stem cells

Your blood passes out of one drip, through the machine and back into your body through the other drip. The machine filters the stem cells out of your blood. The stem cells are collected and frozen until you are ready to have them back.

It is common for patients to feel very tired after donating stem cells. You may get tingling around your mouth or muscle cramps if your calcium level gets low during the collection. If this happens doctors or nurses will give you calcium, usually through a drip.

 

About donor stem cells

Some people have stem cells from another person. These are donor stem cells. They are collected from the donor as described above. 

If you have donated stem cells they need to closely match your own. A brother or sister is most likely to be a close match. Sometimes, if you don't have a brother or sister (a sibling donor) who is a match, you can have stem cells from a donor who is not related to you but whose stem cells are similar to yours. This is called a matched unrelated donor (MUD) transplant.

First, laboratory staff check the surface of your blood cells and the donor blood cells for certain proteins. The proteins are called HLA markers or histocompatibility antigens. So the test is called HLA typing or tissue typing. Everyone has their own set of proteins. Staff compare the proteins on the cells in the blood samples to see how many of the HLA markers are the same. Members of your close family are most likely to have similar proteins to yours. Usually 10 HLA markers are checked before a stem cell transplant. 

The results of your blood test and the donor's test tell your doctor how good the HLA match is between you. You can have a transplant without a perfect match. This is known as a mismatch. If you have a mismatched transplant, you will be more likely to have a reaction after the transplant called graft versus host disease (GVHD). This means the immune cells from the donated stem cells attack some of your body cells. GVHD typically causes skin rashes, diarrhoea and liver damage. You will have anti rejection drugs to help stop it developing. GVHD can be severe and even life threatening in some people. GVHD is not always a completely bad thing. As it is an immune system reaction, mild GVHD can help to kill off any cancer cells that are left after your treatment.

In some cases, your doctor may consider a half matched transplant (haploidentical transplant). With this, the donor is at least a 50% match with you. These transplants are generally between siblings or a parent and their child. In the past these transplants have been difficult to do due to the increased risk of severe GVHD and infection. But doctors are finding new ways of improving this type of transplant and reducing the risk of GVHD.

 

Cord blood stem cells

Some people may have a stem cell transplant using stem cells from umbilical cord blood. There are cord blood banks which store blood taken from the umbilical cord. After the baby is born and the umbilical cord has been cut, a doctor takes blood from the umbilical cord and placenta. The blood bank may then give the donated stem cells to a person whose blood cells closely match the donated cells.

There is information about donating cord blood on the NHS cord blood bank website and the Anthony Nolan website.

 

Mini transplants

Stem cells can be used in mini transplants. These are also called reduced intensity conditioning (RIC) transplants. You have lower doses of chemotherapy than in a traditional stem cell transplant. So this treatment can be given to people who are too old or not well enough for a traditional transplant. Research is going on to see how doctors can best use mini transplants in leukaemia and lymphoma treatment. There is information about this in the pages about research for each particular type of lymphoma or leukaemia.

 

More about stem cell transplants

We have information about having a transplant in this section. 

If you would like more information about anything to do with stem cell transplants, you can phone the Cancer Research UK nurses. The number is freephone 0808 800 4040 and the lines are open from 9am to 5pm, Monday to Friday. You can also send the nurses a question. They will be happy to help.

The Anthony Nolan charity has helpful information. They have a register to match people willing to donate their bone marrow or blood stem cells to people who need transplants. They also provide information, support and an online forum for patients and families going through a transplant. You can find out about them on their website at www.anthonynolan.org.

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Updated: 16 March 2015