What happens during a stem cell transplant

A stem cell or bone marrow transplant is a long and complicated process that involves five main stages.

These stages are:

1. Tests and examinations to assess your general level of health.
2. Harvesting the process of obtaining the stem cells to be used in the transplant, either from you or a donor.
3. Conditioning treatment to prepare your body for the transplant.
4. Transplanting the stem cells .
5. Recovery you'll need to stay in hospital for at least a few weeks until the transplant starts to take effect.

The stages are described in more detail below. You can use the links above to navigate to each section.

Tests and examinations

Before a stem cell transplant can be carried out, you'll need a series of tests and examinations to ensure you're healthy enough for the procedure to be carried out.

Transplants tend to be more successful in people who are in good general health, despite their underlying condition.

The tests you might have include:

• an electrocardiogram (ECG) a simple test used to check your heart's rhythm and electrical activity
• an Echocardiogram a scan used to look at the heart and nearby blood vessels
• an X-ray and/or computerised tomography (CT) scan to check the condition of organs such as the lungs and liver
• blood tests to check the level of blood cells and assess how well the liver and kidneys are working

If you have cancer, you may also need to have a biopsy . This is where a small sample of cancerous cells is removed and analysed. It canshow whether your cancer is under control (in remission) and whether there's a high risk of it returning after your transplant.

Harvesting stem cells

After you've had tests to check your general health, the stem cells that will be usedfor the transplant will need to beremoved and stored.

There are three main ways stem cells can be harvested, these are:

• from blood where the stem cells are removed from your blood using a special machine (see below)
• from bone marrow where a procedureis carried out to remove a sample of bone marrow fromthe hip bone (see below)
• from cord blood where donated blood fromthe placenta and umbilical cord of a newborn babyis used as the source of stem cells (find out more from the NHS Cord Blood Bank )

It may be possible to remove stem cells from your own blood or bone marrow and transplant them later after any damaged or cancerous cells have been removed.

If this isn't possible, stem cells from a donor's blood or bone marrow will usually be used.

Removing stem cells from blood

Themost common way to harvest stem cells involves temporarily removing blood from the body, separating out the stem cells, and then returning the blood to the body.

To boost the number of stem cells in the blood, medication that stimulates their production will be given for about four days beforehand. On the fifth day, a blood test will be carried outto check there are enough circulating stem cells.

If there are enough cells, veins in each arm will be connected by tubes to a cell-separator machine. Blood isremoved from one arm and passed through a filter, before being returned tothe body through the other arm.

This procedure isn't painful and is done while you're awake. It takes around three hours and may need to be repeated the next day if not enough cells are removed the first time.

Removing a bone marrow sample

An alternative method of collectingstem cells is to remove around a litre of bone marrow from your hip bone usinga needle and syringe.

The needle may need to be inserted into several parts of your hip to ensure enough bone marrow is obtained. This isdone under a general anaesthetic , so you'll be asleep and won't feel any pain while it's carried out.

However, the area where the needle is inserted may be painful afterwards and you'll have two marks on your skin where the needles were inserted (usually one on each side).

Conditioning treatment

Treatment with high doses of chemotherapy and sometimes radiotherapy will be needed before the stem cells can be transplanted to:

• destroy existing bone marrow cells this is to make room for the transplanted tissue
• destroy any existing cancer cells
• stop your immune system working this is to reduce the risk of the transplant being rejected

As part ofthe conditioning treatment, you'll be given a range of medicines, so a tube called a central line will usually be inserted into a large vein near your heart. This means medication can be passed into your body withoutthe need fornumerous injections.

The conditioning process usually lasts up to a week. You'll probably need to stay in hospital throughout the treatment.

Conditioningcan cause a number of unpleasant side effects, such as sickness, hair loss and tiredness. These are usually temporary. Your treatment team will discuss the risks of treatment with you beforehand.

This process often takes around a couple of hours.

The transplant won't be painfuland you'll be awake throughout.

Recovery

Once the transplant is finished, you'll need to stay in hospital for a few weeks while you wait for the stem cells to settle in your bone marrow and start producing new blood cells.

During this period you may:

• feel weak, and you may experience vomiting, diarrhoea and/or a loss of appetite
• be given fluids by mouth or through a tube running from your nose to your stomach (a nasogastric tube) to prevent malnutrition
• have regular blood transfusions , as you'll have a low number of red blood cells
• have regular platelet transfusions, as you'll have a low number of platelets
• stay in a special germ-free room, and visitors may need to wear protective clothing to prevent infections, as you'll have a low number of infection-fighting white blood cells

Many people are well enough to leave hospital between one and three months after the transplant. However, if you develop complications such as an infection, you may not be able to leave hospital for longer.

Even after going home, you'll still be at risk of infections for potentially a year or two because it can take a while for your immune system to return to full strength.

If donated stem cells were transplanted, you'll also usually need to take medicines that stop your immune system from working so strongly, to reduce the risk of your body attacking the transplanted cells (immunosuppressants), or to reduce the risk of the transplanted cells attacking other cells in your body.