What is a Stem Cell Transplant?
Stem Cells are the cells that are produced in the bone marrow of a human body. They are produced to become any cells that the body requires. Stem cells when mature, become RBCs, WBCs, or blood platelets.
Stem Cell replacement is a procedure in which a patient receives healthy blood cells to replace the damaged stem cells caused by strong chemoradiation while undergoing cancer treatment. Stem Cell replacement is also done to replace the affected stem cells due to naturally occurring diseases. Anemia and bleeding are the most common symptoms of damaged Stem cells in the human body.
Before a stem cell replacement, the patient is required to undergo strong chemoradiation to prepare for the transplant and this process of conditioning the body to accept new stem cells from a donor is called ‘Conditioning treatment’. After a Stem Cell Transplant, the donor cells move to the bone marrow of the recipient to form new healthy blood cells. This process is called ‘Engraftment’.
Stem cell replacements can be broadly classified into 6 kinds. They are:
- Autologous Stem Cell Transplant
- Allogeneic Stem Cell Transplant
- Hematopoietic Stem Cell Transplant
- peripheral blood Stem Cell Transplant
- Bone marrow Stem Cell Transplant and
- Cord Stem Cell Transplant
While Autologous and Allogeneic transplantations are the most common forms of Stem Cell Transplants. Sometimes, depending on the nature of the condition, patients are advised Reduced Intensity Stem Cell Transplants and Syngeneic transplantation too.
Why is a Stem Cell Transplant done?
Stem cell replacement is a part of the bone marrow transplant. This is done to replace the affected stem cells to improve the bone marrow’s efficiency to produce new blood cells after conditioning treatment or radiation therapy.
After radiation therapy or conditioning, the body is exposed to large volumes of anti-carcinogenic elements that kill cancerous cells. In this process, the bone marrow is also affected and loses its capability to produce new blood cells. At this point, the immune system of the body is weak as there are no white blood cells and stem cells being produced. With a Stem Cell Transplant, the host (patient) is induced with healthy stem cells that move to the bone marrow and form new blood cells and strengthen the immune system to fight the remnant cancer cells that are weakened after radiation.
Types of Stem Cell Transplants:
Autologous Stem Cell Transplant
Autologous Stem Cell Transplant is a procedure that uses the patient’s own blood cells to produce new stem cells. In this process, the patient undergoes ‘Cell mobilization’: a process that encourages the body to produce more stem cells and initiates the movement of the stem cells from the bone marrow to the bloodstream. Stem-cell rich blood is then collected from the patient and processed into a machine that separates the stem cells from the blood. Then, it is stored in sub-zero conditions for later usage.
This rest of the blood is sent back to the patient’s body, post which the chemotherapy treatment begins. Chemotherapy’s strong radiation regimen kills all cancerous cells, but it also destroys the blood-producing cells in the bone marrow.
The major advantage of Autologous Stem Cell Transplant is that it does not expose the patient to any risks in terms of Graft vs host adoption.
Allogeneic Stem Cell Transplantation
In Allogeneic Stem Cell Transplants, the patient receives stem cells from a donor and is executed after the patient undergoes conditioning treatment or chemotherapy. In this process, the stem cell-rich blood of a matching donor is processed in a machine that separates stem cells from the blood and is transferred into the host’s body.
After conditioning treatment and chemotherapy, the blood making cells are severely damaged and hence the immune system tends to be weak.
The new stem cells from the donor are induced into the body for engraftment. In this process, the new stem cells travel to the bone marrow and begin to form new blood cells.
In allogeneic Stem Cell Transplants, the immune system of the host tends to become stronger as the new stem cells form a new immune system and the new blood cells formed also tend to be very effective in removing the remaining cancerous cells in the body. This is called the graft versus tumor effect.
Allogeneic Stem Cell Transplants are successful when the HLA (Human Leukocyte Antigens) found in the white blood cells are the right match. Donors are tested for compatibility with a series of HLA tests.
Most matches in HLAs are from:
- HLA-matched unrelated donor
- HLA miss-matched family member
- Unrelated umbilical cord blood
- HLA-matched relative (most often a sibling)
Hematopoietic Stem Cell Transplant:
Hematopoietic Stem Cell Transplant is an intravenous cell replacement process that induces stem cells to replace the damaged cells affected by radiation treatment.
Hematopoietic Stem Cell Transplant has been in widespread use from the early 1960s and has been prominent in treating and curing carcinogenic and autoimmune diseases. Multiple Sclerosis is often treated with this method.
Peripheral blood stem transplant:
Peripheral blood stem transplant is a form of hematopoietic Stem Cell Transplant (HSCT) that is used in Autologous and Allogeneic Stem Cell Transplants. In this process, the stem cells are collected from the blood rather than the source, i.e the bone marrow. This process is less invasive and can be conducted from an authorized Peripheral blood stem cell (PBSC) centers. The same blood that is found in the bone marrow is found in the bloodstream. This process is chosen depending on the type of the disease, the stage of severity, age, and other conditions of the patient.
Bone marrow transplant:
Bone marrow transplant is a procedure that replaces the cells that are produced by the bone marrow. Bone marrow is a soft tissue that is present inside the bones in the form of a soft tissue. Stem cells are produced by the bone marrow and these stem cells become red blood cells, white blood cells, and blood platelets or form new stem cells if required. Certain cancerous and non-cancerous diseases affect the bone marrow and hence the stem cells being produced are also affected. In a bone marrow transplant, the cells are either replaced through an invasive procedure from the bone marrow or through a non-invasive intravenous procedure through the veins. Invasive bone marrow tissue transplants are only recommended when the disease is a potential threat and if the patient’s physical conditions and age supports it.
Cord blood Stem Cell Transplant:
Cord blood Stem Cell Transplant is a process that is witnessing increased adoption across the world. Like the peripheral blood and bone marrow, the umbilical cord is also a rich source for stem cells. Cord blood Stem Cell Transplants are most effective in treating children and have seen efficient results in the case of adults.
With a cord blood Stem Cell Transplant, the chances of the patient experiencing Graft vs host disorder is significantly reduced. Adding to that, Cord blood Stem Cell Transplants are the least risky in terms of transmission of diseases when compared to the other types of Stem Cell Transplants.
Preserving Cord blood stem cells is also easier, as they have a longer shelf life. Though a definitive figure on its shelf life has not been released, there are cases where cord stem cells from 10 years ago were used successfully.
Diseases and conditions that require Stem Cell Transplantation
Multiple Myeloma is a condition that requires a Stem Cell Transplant as a viable treatment option. Multiple Myeloma is a condition in which the plasma of the white blood cells are affected. Plasma cells generate antibodies that identify and attack foreign bodies. In multiple Myeloma, affected plasma cells tend to overcrowd the bone marrow: the cell generating factory and cause complications. Cancer infected plasma cells, instead of producing healthy antibodies produce abnormal cells.
Leukemia is caused when certain cancerous cells attack the white blood cells. White blood cells are essential for fighting foreign objects and disease-causing agents. Normally, white blood cells divide and grow according to the requirements of the body. However, when infected with Leukemia, White blood cells function abnormally and this can cause several severe complications. A Stem Cell Transplant after conditioning treatment or radiation therapy can help the body build a new immune system that can also fight off the remaining weakened cancer cells.
Non-Hodgkin Lymphoma is a cancer that originates in the Lymphatic cells and spreads throughout various parts of the body. The effect of this is intensified as the lymph nodes are the body’s network for fighting diseases and hence, are spread across the body. Non-Hodgkin's lymphoma occurs when lymphocytes portray an irregular cell regeneration cycle. Normally, lymphocytes are created, they grow and divide and eventually perish, thus making room for new cells to be created. In patients with this condition, the birth rate and mortality rate of Lymphocytes is not constant, the older and weaker lymphocytes do not perish and tend to overcrowd the lymph nodes.
Hodgkin Lymphoma is a disease that is either passed on through genetic mutation or is caused by Epstein-Barr-Virus. The prime age for a patient to be affected by Hodgkin Lymphoma is either when they are between 15-30 years or after 55. Chemotherapy and radiation therapy are effective ways to cure or treat Hodgkin's Lymphoma depending on the severity of the condition. A Stem Cell Transplant enables the body with a fresh set of cells to equip the body to fight off the weakened cells and create a new immune system.
Myelodysplastic syndrome (MDS):
Myelodysplastic Syndrome is a condition in which the blood cells are not fully matured hence are not released from the bone marrow. While this has no early-stage symptoms, the progression of MDS can cause shortness of breath, make the body susceptible to a lieu of infections, and eventually lead to Leukemia.
A Stem Cell Transplant can slow the progression of MDS to leukemia and when treated in early stages can be an effective cure.
Myelofibrosis is an uncommon form of cancer that causes scarring in the bone marrow. This leads to severe anemia, loss of blood platelet count, excessive bleeding and other complications. Myelofibrosis and its severity depends on a case to case basis. There have been instances where Myelofibrosis, when left untreated, did not pose any immediate threat or any probable future threat. And in a few instances, strong chemoradiation therapy is used either as an option for treatment or cure.
A Stem Cell Transplant is an effective way to create a new immune system and regenerate the immune system.
Aplastic Anemia is a condition in which the body does not produce enough RBCs(oxygen carrying cells), WBCs, (antibodies), and blood platelets(healing cells). Aplastic anemia is generally caused by pregnancy, autoimmune diseases, use of certain drugs, exposure to toxic chemicals, and radiation treatments.
A Stem Cell Transplant embellishes the bone marrow with new stem cells that graft with the body to become new RBCs, WBCs, Blood platelets, or new stem cells.
Autoimmune is a condition in which the antibodies start attacking the soft cell tissues of the body instead of disease-causing agents. This is a genetic disorder and treatment options are suggested based on the severity of the condition. In most cases, reducing the strength of the immune system is suggested.
Risks associated with Stem Cell Transplants
It is important to know the risks associated with Stem Cell Transplants as they help the treating doctors and the patient involved make an informed decision about the treatment options.
Major risks associated with Stem Cell Transplants include:
- Graft Vs Host Syndrome
- Scaly skin, itching, and Rash
- Nausea, Vomiting, and abdominal cramps
- Dry mouth, damaged lungs, esophagus and other organs
- Loss of appetite
- Weight loss
- Cataract and
The Stem Cell Transplant procedure
The process of undergoing a Stem Cell Transplant is risky and not every patient is advised to undergo this process due to factors which include the patient’s prior medical history, his/her ability to withstand the radiation treatment and its side effects. For some patients, a reduced intensity of allogeneic treatment is advised.
Salient factors that are considered before a patient is administered Stem cell replacement are:
- The patient’s general health conditions
- Previous medical history
- Severity of the condition
- The probability of the body responding to the treatment
- Availability of stem cells either from self or a donor
Stem Cell Transplant is strenuous on the body and hence the patient is advised to discuss options on Medical tests, fertility, Intravenous Catheter insertion, costs involved and caregiver.
Medical tests: Before a Stem Cell Transplant is chosen, the patient is asked to undergo a series of medical tests to understand the condition of the body and predict the outcome of such a procedure.
Fertility:In a Stem Cell Transplant the patient is exposed to harmful amounts of radiation and this can affect the fertility of the patient. If the patient is of a birth-giving age or is considering giving birth in the near future, then, options on storing eggs or sperm should be discussed with a physician.
Intravenous catheter insertions: An insertion of a central line in the body is essential as the patient will be undergoing a lot of blood transfusions, injections, chemotherapy, and other fluids and this can be painful if done without the insertion of a central line.
Cost involved: A stem cell replacement transplant is an expensive procedure and when this procedure is being considered as a treatment option, the patient should disclose their financials with the medical team. Most insurance policies cover most of the expenses incurred in this, however, it is always advisable to talk to the insurance companies to understand every minor detail involved to ensure that no new major expenses are uncovered during the process of stem cell replacement.
Stem Cell Transplant Criteria and Requirements
The best way to know if you or your family member/s are eligible for a Stem Cell Transplant is to contact your doctor or the hospitals that support Stem Cell Transplants.
The test involved to decide the eligibility criteria include:
- Psychological evaluation
- Blood tests
- Bone marrow tests
- Chest X-rays and CT scans
- Heart, lung, and other organs function check
Finding a Donor
Finding a donor for a stem cell replacement is a long and often arduous process as a good match happens in only 3 out of 10 cases in unrelated donors and in 5 out of 10 cases in related donors.
The patient undergoing the Stem Cell Transplant will be the first priority as the stem cells from his/her own body are very unlikely to be rejected by the body in GVHS after the transplant. However, the medical team will test to see if you are a good donor based on your weight, general conditions, and severity of the condition and the rate at which the existing stem cells are affected.
Siblings are generally considered the next best options when looking for an HLA matched donor. Due to the genetic composition of the HLA from their biological parents, siblings have a higher chance of being a good HLA match for an allogeneic Stem Cell Transplant.
When siblings are not HLA match, the search for a donor is begun and the existing cells in the storage facility are combed through to find stem cells or umbilical cords which match the HLA of the patient. Furthermore, volunteers who sign up for Stem Cell Transplants are also contacted to see if they are a potential match for the procedure.
Road to Recovery and Aftercare
The road to recovery after a stem cell replacement transplant is very exhaustive and intensive as the immune system of the patient becomes similar to that of a newborn baby. The caregiver and patient are coached on how to navigate this transition by the medical team and any concerns or queries are addressed before the patient is discharged from the hospital.
Medical Alert Jewelry:
Before leaving the hospital, a bracelet or a necklace engraved with ‘Autologous Stem Cell Transplant’ or ‘Irradiated cellular blood components and CMV-safe blood components only’ is provided to the patients. This comes handy when you are being examined/treated by medical experts and you are not in a position to give information on your recent transplant. This helps the medical team treating you consider your history and administer effective medical judgement.
After a prolonged stay at the hospital, going back home and being surrounded by your loved ones can surely be something to look forward to. But, after multiple rounds of chemotherapy and blood transfusions, going back home and feeling the same about it can be slightly challenging.
But with time, patients tend to adjust to their old surroundings and things that stress them do not have the same effect.
Animals carry a variety of diseases and it is not advisable to be around pets or animals for at least 12 months after treatment as the immune system is very weak and the chances of catching an infection are very high.
Always drink and eat from neatly washed utensils. Wear clean clothes that are properly dried under the sun. When at home, avoid touching soil or plants and when done, ensure that there are gloves and masks used.
Do not use a humidifier at home as it creates a musty environment which is a perfect breeding ground for bacteria.
Friends and family visitation:
There are no restrictions on who you meet. However, it is advisable to meet people in small groups.
Active efforts should be made to ensure that people with these conditions should not have direct contact with the patient:
- Anybody who has a cold
- Anybody who has chickenpox
- Anybody who has been recently exposed to chickenpox
- Anybody who has been recently exposed to Herpes virus
- Anybody who has been exposed to shingles or other forms of infections
- Anybody who has received a live-virus vaccination
It is advisable to consult your doctor before resuming your sexual life. It is strongly advised not to involve in oral, vaginal, and anal sex if the platelet count is under 50,000 units.
- Use latex condoms if you are participating in oral, vaginal, or anal sex. If you are allergic to latex, contact your medical practitioner for medical alternatives.
- Use condoms or dental dams to prevent the discharges from entering your mouth during oral sex
- Use condoms so that you don’t get pregnant. If you are considering getting pregnant, it is recommended to contact your medical practitioner to be aware of the recovery stage you are in and the possibilities of complications, if any.
After a Stem Cell Transplant, you may have fewer or no menstrual periods along with itching and dryness in the vaginal region.
Using skin products that reduce dryness in vaginal regions is advisable. There are creams available with zero hormones that can be obtained without a prescription either online or at a local pharmacy.
After a Stem Cell Transplant, you could experience erectile dysfunction and this might affect your personal life. However, this is temporary and this condition can be improved with regular exercise.
This condition can also be treated with medications like Viagra.
Consumption of Alcohol and Tobacco:
Consumption of tobacco or any tobacco-based products like cigarettes, cigars or marijuana is strictly prohibited after undergoing a stem cell replacement transplant.
Consumption of alcohol is also prohibited as it may damage the kidney and the effect could multiply at a rate faster than usual due to a suppressed immune system.
It is advised to consult a doctor to talk about when is it safe for alcohol consumption, after the transplant.
After a stem cell replacement transplant, the patient may develop a cataract and hence, it is advised to visit an ENT specialist.
It is advised to consult a doctor if:
- The vision is blurry or foggy
- If you witness any change when viewing colours
- If you have problems driving at night
- If you are experiencing double vision
Stem Cell Transplant FAQs: All your concerns addressed.
Q. How long will I be in the hospital if I am undergoing a stem cell transplant?
- The duration of stay varies from 3-4 weeks depending on the nature of the stem cell transplant treatment you will be receiving. If its an autologous process, the duration of stay is 3 weeks and it is 4 weeks for an allogeneic stem cell transplant.
Q. How soon after a stem cell transplant can I get back to work?
- Getting time to recover completely is more important as the immune system is weakened and the body is susceptible to attacks more than ever. It is advised to return to work 3-6 months after an autologous stem cell transplant and the time period is 6-12 months for an allogeneic process. However, it is recommended to consult a medical practitioner before considering going back to work.
Q. What are the most common stem cell transplants?
- The most common ones are:
- Autologous stem cell transplant
- Allogeneic stem cell transplant
- Cord transplant
- Reduced intensity transplants
Q. Which of these is best suited for me?
- According to the nature and severity, and availability of donor stem cells, your consulting cardiologist will take a call on the best suited treatment option. Before finalizing on a stem cell transplant, various factors are considered to ensure that the possibilities of any complications after the procedure is avoided.
Q. I am a caregiver, what are the things I should keep in mind while caring?
- The caregiver and the patient experience a very close relationship in the road to recovery after the procedure. Before you leave the hospital premises, the doctor will walk you through the steps involved in how to navigate the road to recovery.
Q. How does a stem cell transplant work?
- The stem cell transplant team works in coordination with the patient, family and the referring physician to deliver the best possible care and outcome. The procedure of transplant may differ in patients, but in general, it includes the following.
- Pre-transplant testing
- Deciding which type of transplantation will be most appropriate – autologous or syngeneic or allogeneic
- Extracting stem cells from the patient or a donor – Stem cells can be obtained through a process called apheresis. It is a painless procedure and involves taking the blood from a vein and circulating it through a machine which can remove the stem cells and send the remaining blood and plasma back to the patient.
- The bone marrow stem cells are harvested from the donor by placing a needle in the soft centre or marrow of the bone. The procedure may cause some pain to the donor after it is complete.
- Conditioning – In conditioning treatment, chemotherapy and radiation therapy is given to the patient to destroy the affected cells. This creates space in the bone marrow so that the transplanted stems can populate.
- Infusion of healthy stem cells – The stem cells are transplanted to the patient through intravenous infusion.
- Engraftment and recovery – The transplanted stem cells enter the blood and bone marrow and start producing healthy cells. The engraftment process can take two to three weeks, and the patient will have to stay in the hospital during this period to monitor their condition and side effects.
Q. What are the typical side effects and recovery time after a stem cell transplant for myeloma?
- The side effects of stem cell transplantation are mostly caused due to the use of chemotherapy in high-doses. It can cause nausea, vomiting, diarrhoea, skin rash, mouth sores and hair loss. Individuals undergoing chemotherapy are also susceptible to bleeding, anaemia and infection as blood-producing cells are destroyed in the process.
If the transplant was performed using your own stem cells (autologous transplant), you can expect to stay in the hospital for about two weeks or less. Usually, it takes two to three months to recover physically following such a procedure, and it may take a year to get back on your normal routine. However, if you have a desk job, you can resume working within one to two months provided that your blood counts have stabilised within that time.
If you had an allogeneic stem cell transplant that uses the donor’s cells, four to six weeks is the minimum that you need to stay in the hospital. The stay may be longer if you develop GvHD, a condition in which the donor’s immune system turns against the patient’s cells.
Q. What complications can develop from stem cell transplants?
- Some common complications that can develop from autologous transplants are:
- Bleeding and anaemia
- Interstitial pneumonia - Inflammation of the tissues in the lungs
- Liver damage
- Dry and damaged mouth, oesophagus and other organs
- Infertility, in some cases, where total body radiation is given
- Secondary cancers
- Graft versus host disease or GvHD – Around 30 to 70 per cent of the patients will experience some form of GvHD, where their cells may be treated as foreign bodies by the donor cells and attacked. It can be mild and severe as well. The symptoms of GvHD are rashes, scaly and itchy skin, hair loss, liver problems like jaundice, abdominal cramps, etc.
- Graft failure – It is a rare complication, which occurs when the donor cells are rejected by the recipient’s body. To fix this, a second transplant may be required, or else, an infusion of residual lymphocytes may be given from the donor.
- Cancer relapse – Cancer relapse may happen if all the cancer cells weren’t destroyed in chemotherapy and radiation. In case of some aggressive cancers, the relapse rate could be quite high.