There are six major steps involved in getting an allogeneic stem cell transplant.
Step 1: Know if a transplant is right for you, and prepare for the transplant
You will have a meeting (consult) with the transplant team to discuss your health.
At the consultation you will meet your transplant doctor and transplant nurse. The transplant doctor will review your health history. Your disease and overall health are discussed to see if an allogeneic stem cell transplant is the right treatment for you.
A suitable donor must also be identified. The transplant team will search for a donor whose stem cells “match” your own by:
- Testing your brothers and sisters (siblings) and sometimes other close family members if they are willing and eligible to donate
- Searching a worldwide list of possible stem cell donors
Several factors will determine who is the best type of donor for your transplant. In the past a perfect match was thought to be the best. Now, with more research and new treatment protocols, near-perfect matched donors or haploidentical donors can also be good options. The transplant doctor will choose the best donor option for your transplant.
In general, the better match your donor is, the less likely it is that:
- Your immune system with fight the donor’s stem cells
- The donor’s stem cells will attack your body
Your transplant doctor will discuss further details about our transplant such as type, location and timing at your initial consultation
Your health care team at London Health Sciences Centre includes:
- Your hematologist/oncologist
- Your transplant doctor
- Nurse Practitioners
- Specialized transplant clinic, apheresis and inpatient nurses
- Social worker
- Administrative assistants
- Training doctors (called residents or fellows)
- Physiotherapist
- Occupational therapists
- Dietitian
- Dentist
Step 2: Pre-transplant tests
You will need to do some basic tests and procedures as part of the assessment for moving forward with transplant. Your health care team needs to know if your cancer is under control, how much of it is still there, and if your body can handle the transplant.
Your disease status needs to be assessed and usually includes a bone marrow examination. For some patients you may also require lumbar puncture.
The pre-transplant tests include tests of lung function, blood tests, heart function tests, CT scans and a dental exam. We will arrange these tests for you.
If your donor is related to you, they will have a separate assessment by a different transplant doctor at LHSC. Once screened, tested, and cleared to donate, their cells will be collected, labelled with a unique identifier and stored in the Transfusion Medicine Department until you are ready for the stem cell transplant.
If your donor is not related to you, their assessment will be done by a transplant doctor at the site where their cells are being collected. Once the donor is screened, tested and cleared to donate, the donor stem cells will be collected and labelled with a unique identifier. The cells will then be picked up and delivered to LHSC by a professional courier with specialized training in stem cell transport.
Step 3: Pre-transplant appointment
At the pre-transplant appointment your transplant doctor will review the results of your pre-transplant tests and determine if you are ready to go ahead with transplant. If you agree to go ahead you will sign consent forms.
You will be given information on the type of chemotherapy and/or radiation you will receive. You will also be given a written schedule of dates for admission to hospital for transplant.
Step 4: Admission to hospital for your transplant
When the transplant is confirmed you will be scheduled to come into hospital. There are several processes and procedures that will happen during your admission. These include:
Get a tunneled central intravenous (IV) line put in
You will need a special IV line that is put into one of the large veins in your upper chest.
The central line is used by nurses to:
- Take blood samples during your transplant
- Give you chemotherapy and immunosuppressive therapy
- Infuse your donor stem cells
- Give you transfusions of blood and platelets if needed
- Give you extra fluids and supplements, and medications such as antibiotics (medicine that fight infection).
Get high dose chemotherapy and immunosuppressive therapy with/without radiation (conditioning)
Shortly after being admitted, you will be given high dose chemotherapy and immunosuppressive therapy. You may also require total body irradiation.
These treatments are called “conditioning or preparative regimen”. The purpose of the conditioning regimen is to:
- destroy your diseased cells
- suppress your immune system so that the healthy blood stem cells can begin producing new blood cells
This chemotherapy and immunosuppressive therapy are given in many doses over several days depending on your type of cancer and what your health care team decides. Drugs used in the conditioning regimen are sometimes the same as those used in standard chemotherapy to treat the disease. The dosage, however, may be much higher.
- You will be given extra medications to help prevent nausea and vomiting from chemotherapy and reactions to immunosuppressive therapy
- You may also be given IV fluids to help flush the chemotherapy and immunotherapy out of your system.
Step 5: Infuse your donor stem cells (Get your stem cell transplant)
After getting your high dose chemotherapy and immunosuppressive therapy with or without radiation you will need to wait one to two days before having the donor stem cells infused into your bloodstream.
By waiting at least one to two days after the chemotherapy, your body will have time to flush out the chemotherapy drugs before infusing the donor stem cells. This is called Day 0 (zero).
This donor stem cell infusion is the actual “stem cell transplant” part of your treatment. It is not a surgical procedure. It takes place in your hospital room. The stem cells are infused through your central line, very much like a blood transfusion.
It will take two to four weeks for the donor stem cells to grow and make new blood cells in your body. You will remain admitted to hospital during this time.
Step 6: During your hospital admission/transplant
During your transplant you will be assessed each day by the nurses, nurse practitioners and/or doctors. They will assess your bloodwork and lab results, review which side effects that you may be feeling and determine whether you need any:
- Transfusions
- Replacement of any fluids and electrolytes (minerals) your body needs
- Antibiotics (medicine that fights infection)
- Tests to check for infections
During your hospital stay you can rest or sleep, have visitors, go for walks and do other activities, such as reading, watching videos and playing games.
You will be discharged approximately three to four weeks after your stem cell transplant once your blood counts have started to recover. You will continue to be followed closely by the transplant team in the Verspeeten Family Cancer Centre.
