The conditioning process
After you complete your pre-transplant 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).
Conditioning generally occurs in the week leading up to your stem cell transplant. In some cases, you receive high doses of chemotherapy and total body irradiation (TBI). On the other hand, you may receive only high doses of chemotherapy and no radiation at all. The type of conditioning you undergo depends on your unique circumstances.
The conditioning process may be done in the hospital or on an outpatient basis. It can cause numerous side effects and complications because your bone marrow and stem cells are destroyed in anticipation of the transplant, and even if your conditioning process is outpatient, you may need hospitalization for side effects.
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
- Premature menopause
- 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 non-myeloablative 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. In some cases, they may not be as successful as full transplants.
What you can expect
A bag of stem cells ready for transplant.
During your stem cell transplant
Stem cell transplants are typically performed in specialized medical centers. These centers generally have transplant units, with a team of specialists caring for you. This team often includes doctors, transplant nurses and coordinators, mental health professionals, occupational therapists, and dietitians.
Stem cell transplantation involves infusing, or injecting, donor stem cells through your central line. This usually takes one to five hours. The transplanted stem cells make their way to your bone marrow cavities, where they begin creating new bone marrow and stem cells. It can take several weeks, though, for your blood counts to begin recovering.
If you receive bone marrow or blood stem cells that have been thawed, you may notice an odor in your room for a day or two after the transplant. This is caused by the substance used to preserve the cells.
Just before the transplant, you may receive medications to reduce the side effects the preservative can cause. These side effects include:
- Nausea
- Fever
- Chills
- Hives
Not everyone experiences side effects from the preservative, and for some people those side effects are minimal.
After your stem cell transplant
After your stem cell transplant, you may stay in the hospital until your blood counts recover or you may return home but remain under close medical care. Some people who have inpatient transplants are able to leave the hospital within three to five weeks, but others may face much longer hospitalizations. Some transplant facilities require transplant recipients to remain nearby for 100 days to allow close monitoring.
In the days and weeks after your stem cell transplant, you may have many of the same kinds of tests and procedures to monitor your condition that you had before the transplant. You may also need supplemental nutrition to compensate for nausea and diarrhea.
To combat various complications, you may need to take numerous medications. You may also need periodic transfusions of red blood cells and platelets until your bone marrow begins producing enough of those cells on its own.
Results
It usually takes about a full year for your blood cells and immune system to recover to normal levels after a stem cell transplant. In general, recovery from a stem cell transplant that uses your own harvested stem cells is quicker than one that uses donor stem cells.
A stem cell transplant can cure some diseases and put others into remission. Most people who have a stem cell transplant expect the procedure to extend their life, and it often does.
Some people sail through stem cell transplantation with few side effects and complications. Others experience numerous problems, both short and long term. The severity of side effects and the success of the transplant vary from person to person.
Most people who have a stem cell transplant and don't have a relapse of their disease go on to enjoy a good quality of life. Many are able to return to work or school and resume their normal activities.
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