Stem Cell Transplant

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is a stem cell transplant?

Stem cells are very basic cells capable of making new blood cells. They can create all types of blood cells in the bone marrow, including red blood cells, white blood cells, and platelets. A stem cell transplant restores the body’s ability to make new blood cells when the bone marrow is damaged or diseased from blood cancer, such as leukemia. Bone marrow damage can happen with cancer treatments, such as radiation or high-dose chemotherapy.

There are two types of stem cell transplant:

  • Allogeneic stem cell transplants use donor stem cells.
  • Autologous stem cell transplants use your own stem cells. In this type of transplant, doctors harvest and freeze your stem cells before treatments to wipe out the bone marrow.

Stem cells are present in different areas, including the peripheral bloodstream and the bone marrow. Although bone marrow transplant is what most people are familiar with, advances in stem cell biology and transplant since the 1980s allow doctors to perform peripheral blood stem cell transplants much more frequently than bone marrow transplants.

Why is stem cell transplant performed?

Doctors mainly use stem cell transplant to treat bone marrow and blood-related cancers. It can treat people with leukemia, lymphoma, multiple myeloma, and other blood disorders. Stem cell transplant allows doctors to use high-dose chemotherapy or radiation to destroy the bone marrow. Wiping out the complete bone marrow cell population and replacing it with stem cells restores healthy bone marrow.

Stem cell transplant is also useful after high-dose chemotherapy for other cancers, such as testicular cancer. In this case, the goal is to use very high chemotherapy doses for cancers that normal doses will not treat. Bone marrow cell destruction is a side effect of this treatment. Stem cell transplant treats the side effect by replacing the damaged bone marrow.

How is stem cell transplant procedure performed?

In the past, doctors had to get stem cells directly from the bone marrow. This is a bone marrow transplant. Today, doctors perform peripheral blood stem cell transplants by collecting stem cells from circulating blood—either your own bloodstream or from a donor. These are hematopoietic (heh mah ta poy EH tick) stem cells, which, like bone marrow stem cells, give rise to new, healthy cells that make up your bone marrow and immune system.

They use a process called apheresis to collect the cells. It circulates your blood through a machine to separate out the stem cells and return the remaining blood to your body. You or your donor will have an intravenous (IV) line in each arm that connects to the machine. It can take several apheresis sessions to collect enough hematopoietic stem cells. Then, they prepare the stem cells for transplant. Another name for peripheral blood stem cell transplant is hematopoietic stem cell transplant, or HSCT.

When it is time to transplant the cells, doctors infuse them into the bloodstream. You must have a central venous catheter (CVC) for this procedure. A CVC is larger than a regular IV for placement into a larger vein. Placing this catheter is an outpatient procedure. It usually takes place within 10 days of the transplant if you don’t already have one.

After infusion, the transplanted stem cells circulating through your bloodstream naturally migrate to your bone marrow. Once they are in the bone marrow, they multiply and restore the population of stem cells as well as create new white blood cells (infection-fighting cells), platelets, and other blood cells circulating through your bloodstream.

What are the risks and potential complications of stem cell transplant?

Stem cell transplant carries a unique set of potential complications compared to other medical procedures. Complications can happen before or during the procedure or afterward during stem cell transplant recovery. Some of these complications may be serious or even life threatening.

Before the stem cell transplant

Some patients receive high-dose chemotherapy or total body radiation before the stem cell transplant. General complications of high-dose chemotherapy or radiation can include nausea, vomiting, hair loss, respiratory problems, and mouth sores.

During the stem cell transplant

Your team will monitor you closely during the stem cell transplant. While the stem cells are infusing, you may experience the following:

  • Chest pain
  • Pain

Potential complications after the stem cell transplant

Complications are possible following a stem cell transplant including:

  • Breathing problems due to infection, fluid overload, bleeding, and graft-versus-host disease
  • Fluid overload from IV fluids or pre-transplant chemotherapy (if this is part of your stem cell transplant procedure)
  • Infections. It can take up to six months for your immune system to be fully functional and protect you from infections. Until this time, you are at increased risk for bacterial, viral and fungal infections, and old viral infections can reactivate. Your transplant team will watch you closely for signs and symptoms of infection.
  • Low red blood cells causing anemia or low platelets, which can lead to serious bleeding
  • Organ damage due to infection, fluid overload, or graft-versus-host disease
  • Transplant problems including transplant failure (called graft failure) and graft-versus-host disease, which happens when the donor’s cells begin attacking the recipient’s tissues. This is only an issue with allogeneic transplants.

Reducing your risk of complications

It is not always possible to prevent complications from a stem cell transplant. Your team will follow you closely for early signs of a problem and treat you as soon as possible. You can help reduce your risk of certain complications by:

  • Following the strict procedure instructions for activity and diet before your procedure and during recovery. Most patients will be in the hospital following the transplant, which makes it easier to follow the care instructions.
  • Making and attending all required transplant center visits for follow-up and testing
  • Notifying your nurse or doctor of any concerns, such as fever, stomach upset, trouble breathing, or increase in pain
  • Taking your medications exactly as directed

How do I prepare for stem cell transplant?

You will likely go to the transplant center up to 10 days before the transplant for inpatient care. Preparations for the stem cell transplant will vary depending on the reason you need it and if you are using a donor or not.

Questions to ask your doctor

Making a list of questions can help you remember everything you want to ask during your appointments. Questions you may want to ask your doctor include:

  • What is involved in a stem cell transplant? What other treatments will I need?
  • Will you use my own stem cells or do we need to find a donor? What are the pros and cons of each option?
  • How long will the stem cell transplant take?
  • What restrictions will I have after the transplant?
  • When will I be able to go home?
  • When can I return to work and other activities?
  • How often will I need follow-up visits with you or at the hospital?
  • How and when will you know if the transplant was a success?
  • What is my prognosis, or long-term outlook?

What can I expect after a stem cell transplant?

Knowing what to expect makes it easier to plan and prepare for a successful recovery.

How long will it take to recover?

A stem cell transplant involves significant recovery time. You will likely spend several weeks in the hospital after the transplant. This allows your team to closely monitor you for complications. They will also check your blood counts frequently. This helps them gauge the progress of engraftment—when the stem cells begin making new blood cells in the bone marrow.

During your hospital stay, you will be very susceptible to infections. You will most likely be confined to a clean environment to prevent exposure to germs.

Once you are home, full recovery can take several months or longer. Until you have fully recovered, you will not be able to work or engage in other activities that would put you at risk for complications.

Will I feel pain?

You may feel pain or discomfort during the stem cell infusion, but pain can also be a sign of a complication. Tell your doctor about any pain you feel during or after the infusion and throughout your recovery.

When should I call my doctor?

You will have frequent follow-up visits after you return home from the hospital. If you have questions between these visits, call your doctor’s office or transplant center during normal business hours. Your transplant team may also give you instructions for after-hours concerns. Call your doctor right away or seek immediate medical care if have:

  • Fever. Your doctor will give you instructions about when to call for a fever.
  • Skin rash or eye irritation
  • Unexpected bleeding

How might a stem cell transplant affect my everyday life?

You will need continuous follow-up care after a stem cell transplant. Your long-term outlook after the transplant will depend on several factors. This includes your age, your overall health, the type of transplant, and whether you develop complications. If you used donor stem cells, you will need medicine to prevent graft-versus-host disease. Your doctor is the best resource to help you understand your prognosis after a stem cell transplant.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Feb 18
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Bone Marrow Transplantation. Johns Hopkins University.,p00086
  2. Graft vs Host Disease: An Overview in Bone Marrow Transplant. Cleveland Clinic.
  3. High-Dose Chemotherapy and Stem Cell Transplant for Testicular Cancer. American Cancer Society.
  4. Stem Cell Transplant. National Cancer Institute.
  5. Stem Cell Transplants in Cancer Treatment. National Cancer Institute.
  6. Stem Cells: What Are They and What Do They Do? Mayo Foundation for Medical Education and Research.
  7. Types of Stem Cell Transplants for Cancer Treatment. American Cancer Society.
  8. Korbling M, Freireich EJ. Twenty-five years of peripheral blood cell transplantation. Blood. 2011;117(24):6411-6.
  9. Rondón R, Saliba RM, Chen J, et al. Impact of Fluid Overload as New Toxicity Category on Hematopoietic Stem-cell Transplant Outcomes. Biol Blood Marrow Transplant.2017;23(12):2166-2171.