Phase 3: The Stem Cell Collection or Donor Typing
Here, two types of transplant are possible.
Autologous (self-donated) stem cell transplant: Two to four weeks before transplant, we mobilize your stem cells from the bone marrow to the blood through the use of chemotherapy plus growth factors or growth factors alone. This will make your bone marrow grow at a rapid rate allowing, the marrow to spill into the blood so our physicians can easily extract the marrow. Next, we collect the stem cells. This collection takes place in the outpatient pheresis department, with one to five procedures necessary to collect a sufficient quantity. After we collect the stem cells, we freeze them and store them in liquid nitrogen.
Allogeneic transplant: If a sibling is the donor, any one of three sources of stem cells may be used for the transplant – the sibling's bone marrow, the sibling's peripheral blood stem cells or stem cells from umbilical cord obtained when the sibling was born. In the case of an unrelated donor, bone marrow usually is used. Recently, the National Marrow Donor Program has permitted the use of stem cells from unrelated donors in very select situations. Umbilical cord blood registries also can be searched for matches, although only highly select patients are currently eligible for umbilical cord blood transplants.
Phase 4: The Actual Transplantation
Again, there are different procedures for the two kinds of transplant.
Autologous transplants: You receive high-dose chemotherapy, radiation therapy or both, followed by the re-infusion of your stem cells. When this is done on an outpatient basis, the average time for therapy and recovery is 21 days. Even though you begin the process as an outpatient, about 50 percent of patients will require inpatient hospitalization for an average of 11 days. Transplants done on an inpatient basis take place in a 26-bed bone marrow and stem cell transplant unit, with an average hospital stay of 21 days.
Allogeneic transplants: While this is the most complex type of transplant, the vast majority of our patients do quite well during their hospital stay. First, you will receive radiation therapy followed by chemotherapy or chemotherapy alone for five to seven days. Then we obtain bone marrow or mobilized peripheral blood stem cells from your donor. We give you immunosuppressive drugs to allow the donor's stem cells to grow and to minimize or prevent rejection of the transplanted cells. You also will receive drugs to minimize graft-versus-host disease (GVHD). You will most likely be in the hospital for three to six weeks.