Stem-cell transplants Some cancers respond well to an extremely high dose of chemotherapy – but such intensive chemo can destroy the stem cells your body needs to produce healthy blood. Stem-cell transplants replenish the body’s stock of stem cells.
How do they work? Cancers including lymphoma, leukaemia and myeloma can be effectively treated with intensive chemotherapy. The problem is that intensive chemo can do terrible damage to the early-stage blood cells inside the bone marrow known as stem cells. The stem cells are the source of all the body’s blood cells.
One way to get around that is to have a stem-cell transplant after your chemo has finished. Sometimes the stem cells used in the transplant have been sourced from the bloodstream, and sometimes they come direct from the bone marrow. That’s why in the past the procedure was commonly called a bone marrow transplant.
How are they done? The stem cells you receive could be your own (harvested before chemo began) or they could come from a donor whose stem cells are similar to your own. When they’re your own it’s called an autologous transplant. When they come from a donor, it’s an allogeneic transplant. Harvested stem cells can be stored for many years.
To begin with, you or your donor is treated with granulocyte-colony stimulating factor (G-CSF). G-CSF boosts the production of stem cells and encourages them into the bloodstream. Later, blood is taken and put into a machine that separates out the stem cells and returns the remaining blood to your body. This takes several hours.
Sometimes stem cells are harvested directly from bone marrow under a general anaesthetic or an epidural. A special needle goes through the skin and the bone (usually the pelvis) and then marrow is drawn into the syringe.
Before you have your transplant, you will have a few sessions of very high-dose chemo, sometimes supplemented by radiotherapy. When the chemo is over, you’ll go on a drip that delivers stem cells straight into your bloodstream to replenish your bone marrow.
The transplant process takes many weeks and you’re likely to be confined to a hospital room on your own for most of that time. During this period, you’re at risk of infection and bleeding problems and, if the stem cells are from a donor, problems with your body rejecting the cells. It’s a complicated procedure with serious risks attached to it and you will find it physically and emotionally draining.
What are the dangers? Both autologous and allogeneic transplants are dangerous procedures. But the complications involved in using a donor’s stem cells rather than your own mean that allogeneic transplants carry more risks.
The advantage of using stem cells that come from a donor is that they’re free of cancer cells and full of healthy immune cells. Ideally, your donor’s immune cells will attack any cancer cells still remaining in your body. However, it’s also possible for the donor’s immune cells to start attacking your healthy cells. This is called graft-versus-host disease (GvHD). The risk of serious GvHD increases with age. That’s why allogeneic transplants (donor transplants) are usually restricted to patients under the age of 55.
Words to know
Allogeneic transplant a transplant using cells sourced from a donor
Autologous transplant a transplant using your own cells
Bone marrow the spongy material inside bones that produces the body’s blood cells
Granulocyte-colony stimulating factor (G-CSF) a protein that stimulates bone marrow to produce white blood cells
Leukaemia cancer of the white blood cells
Lymphoma cancers of the lymphatic system
Myeloma cancer of the plasma cells found inside bone marrow
Stem cells early-stage blood cells found inside the bone marrow
Things to ask
Can I have visitors? You’ll be vulnerable to infection after a stem-cell transplant so there may be restrictions on who can visit you. Visitors might have to put on protective clothing and wash their hands before entering your room. If they’re unwell they may have to stay away.
How will this affect my fertility? Stem-cell transplants and the intensive chemotherapy that goes with them can affect your ability to have children. Ask your care team how your fertility will be affected. Read more about fertility in Planning for a family.
When will things get back to normal? You’ll remain susceptible to infections for many months after the transplant. During that time you’ll have to avoid activities that put you at risk, things like changing nappies and digging in potting mix. Your care team will tell you what to avoid and for how long.
Expert's insight: Professor Sanchia Aranda The success of a stem-cell transplant has a lot to do with how the patient behaves during recovery says Professor Sanchia Aranda, director of cancer services and information with the Cancer Institute of NSW.
“You will have to monitor yourself for signs of infection and take your own temperature. More than likely, the transplant won’t be successful if you aren’t highly engaged in your own recovery. If you get an infection when you’re at home, and you don’t respond by coming to hospital, you could die in three or four hours. Infection is the major risk because you’ve taken away the body’s defence against it.
“The main thing is to have good discussions with your treatment team prior to starting. Don’t be afraid to ask questions – meetings are all part of the routine.
“After the procedure, try and keep yourself as well as possible while your bone marrow is still recovering. You’ll need to stay away from crowds to avoid infection, but also remain active at the same time. Exercise is good for the immune system and reduces fatigue.
“While lying in a hospital bed, you lose muscle mass. Sometimes staff will put an exercise bike in your room for recovery. If you feel up to it, getting on the bike is a fun way to get back on track.”
More help Stem-cell transplants are commonly used in treating leukaemia, lymphoma and myeloma. To find out more about these cancers and to get information about related support services visit the websites below.
Australian Bone Marrow Donor Registry www.abmdr.org.au For more information about bone marrow and stem-cell donations
Photo by Bruce Daly
JOHN STUBBS When John Stubbs needed a stem-cell transplant, he was fortunate enough to match with a marrow donor from Baltimore in the United States, a woman unknown to him then and now.
John was diagnosed with chronic myeloid leukaemia (CML) at age 48. CML is a rare cancer that attacks the blood and bone marrow. The transplant with donor stem cells was a success. Ten years later, John is fit and healthy, going to the gym three days a week.
“About three months out from the transplant, my blood counts were being monitored very carefully and very often. I’d go into hospital twice a week. They want your body to be as clean as possible, because with your immune system down, the risk of infection is so high.
“Knowing that some people who undergo transplants lose a lot of weight, I put on 13 kilograms in that period leading up to the transplant. I went to the gym, I did weights and I ate more protein foods.
“I was in hospital for 17 days in a room isolated from everyone else. I had three days of full-on chemo, then three days of full body radiation twice a day. When it’s time for the new bone marrow to be infused, your old marrow needs to be totally dead.
“After the transplant, it’s work time. The new bone marrow kicks in at days seven to nine. From then on you should be on a good path. I put myself in a good place mentally from the beginning. I’d played competitive sport for years. I was a goal-setter and I adapted a lot of that to the program. I set little goals for myself every day, even something as simple as looking after my hygiene.
“It took me the best part of 12 months to get over it. Your hair will grow back slowly and your muscle definition will return. If you take pride in your body, it may take a while to recover. Just take things one day at a time and set small, achievable goals.”