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Pretransplant tests and procedures
Once donor stem cells become available, you undergo many tests and procedures to assess your health and the status of your condition, and to ensure that you're physically prepared for the transplant.
In addition, an intravenous (IV) catheter is typically surgically implanted, usually in your chest near your neck. This is often called a central line, and it usually remains in place for the duration of your treatment. It's through the central line that the transplanted stem cells will be infused. The central line is also used to collect blood samples, give chemotherapy, provide blood transfusions and even supply nutrition when necessary.
The conditioning process
After you complete your pretransplant tests and procedures, you begin a process known as conditioning. During conditioning, you undergo chemotherapy and possibly radiation in order to:
- Destroy cancer cells
- Suppress your immune system so that your body doesn't reject the transplanted stem cells
The type of conditioning process you undergo depends on a number of factors, including your disease, overall health and the type of transplant planned — whether you get stem cells donated from someone else (allogenic transplant) or whether the stem cells come from your own body (autologous transplant).
In some cases, the conditioning process involves high doses of chemotherapy and total body irradiation (TBI). In other cases, the conditioning process may include only high doses of chemotherapy and no radiation at all. The type of conditioning you undergo depends on your unique circumstances.
Side effects of the conditioning process can include:
- Nausea and vomiting
- Diarrhea
- Hair loss
- Mouth sores or ulcers
- Infections, such as pneumonia
- Bleeding
- Infertility or sterility
- Anemia
- Fatigue
- Cataracts
- Organ failure, such as heart, liver or lung failure
- Secondary cancers
You may be able to take medications or other measures to reduce such side effects.
'Mini' stem cell transplants
A less intense conditioning process is available through what's known as a mini stem cell transplant. It's also called a reduced-intensity conditioning transplant or a nonmyeloablative transplant.
Reduced-intensity conditioning doesn't try to kill all of the cancer cells that may be in your body. Instead, it relies on the donor's immune system cells to fight your cancer cells.
A less intense conditioning regimen may seem attractive because it may pose fewer life-threatening complications. But this kind of transplant isn't appropriate for all situations. Mini stem cell transplants are typically used only for people who can't endure the harsher conditioning regimen, such as people in poorer health, and for people whose disease isn't rapidly progressing.
- Bone marrow transplantation and peripheral blood stem cell transplantation. National Cancer Institute. http://www.cancer.gov/cancertopics/factsheet/Therapy/bone-marrow-transplant/. Accessed Feb. 17, 2010.
- Blood and marrow stem cell transplantation. Leukemia & Lymphoma Society. http://www.leukemia-lymphoma.org/attachments/National/br_1203086953.pdf. Accessed March 12, 2010.
- Aplastic anemia. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/aplastic/aplastic_all.html. Accessed March 12, 2010.
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