The Transplantation Procedure | Aplastic Anemia and MDS International Foundation

The Transplantation Procedure

What medical tests and exams happen before a stem cell transplant?

Your doctors will want to make sure you're healthy enough to have a stem cell transplant. They also will want to find out whether you have any medical problems that could cause complications after the transplant. You may have:

Blood Tests

Before a stem cell transplant, you might have blood tests to check for HIV, herpes, pregnancy, and other conditions. These tests help your doctors learn about your overall health.

Chest X-Ray and Lung Function Tests

A chest x-ray creates a picture of the structures in your chest, such as your heart and lungs. The test can show whether your heart is enlarged or whether your lungs have extra blood flow or extra fluid.
Lung function tests can show whether you have a lung infection or disease. They also show how well your blood is able to carry oxygen throughout your body.

Computed Tomography Scan, Skeletal X-Ray, or Bone Scan

These tests provide detailed images of your body. They're used to see whether you have any tumors in your bones that might complicate a transplant.

Dental Exam

Your doctor may recommend a complete dental exam to check for problems that might cause an infection after your transplant.

Heart Tests

Heart tests, including EKG (electrocardiogram) and echocardiography (echo), are used to find any conditions that might get worse after the transplant.

An EKG detects and records your heart's electrical activity. Echo uses sound waves to create a moving picture of your heart. The picture shows how well your heart is working and its size and shape.

What happens just before a stem cell transplant?

Patients must receive some form of immune suppression prior to SCT in order to allow for engraftment of donor stem cells.  To prepare for the transplant, you may first be given chemotherapy, radiation therapy or both. This treatment kills your unhealthy stem cells. It also kills the cells that make up your immune system. This keeps your immune system from rejecting the new healthy stem cells you will receive.

Initially only high dose of chemo or radiotherapy was used to condition a patient prior to SCT, but recent newer methods have been employed with lower doses of chemo/radio therapy.  This decrease some of the toxicity of transplant but may also lead to a higher risk of relapse of the patient’s bone marrow failure disease.  Retrospective studies [add & link into glossary: retrospective study, a study in which a search is made for a relationship between one (usually current) phenomenon or condition and another that occurred in the past. ] have shown equivalent overall survival in patients who are in remission at time of transplant and receive either high dose or low dose conditioning prior to SCT. Ask your doctor which method will work best for you.
 
Once you are ready, the doctor will infuse healthy stem cells from a donor into one of your veins. These cells travel to your bone marrow and begin to grow and make the healthy blood cells your body needs. This process is called engraftment and may take two to three or even four weeks. Until the donor cells have engrafted, you stay in the hospital or are seen regularly in a clinic so doctors can check your progress.

What is a reduced-intensity transplant?

Reduced-intensity transplants use less intense treatment to prepare for transplantation than that used with higher dose "standard" regimens. They are sometimes also called non-myeloablative transplants or "mini"-transplants. It is important to understand that these are still full transplants. The toxicity is typically less than that seen with higher dose regimens. However, there is still a risk of rejection, just as after a standard transplant, and there may also be higher risks of non-engraftment and recurrence of the disease being treated. This type of transplant is generally used with older patients (over age 60) and patients with certain medical problems.

What happens after a SCT?

The first few months after a stem cell transplant are important. After you leave the hospital, your immune system may still be very week. Your doctor will likely have suggestions to help your family prepare your home to ensure you have a safe and healthy place to be while your body continues to heal. Because each patient has unique issues and concerns, here are some areas you might want to talk to your doctor about:

  • Preventing infections
  • Contact with or caring for children
  • Pets
  • Cleaning your home
  • Dietary restrictions—what can you eat? What should you stay away from?
  • What follow up medical tests will you have?