- What we’ll cover here
- What are stem cells and why are they transplanted?
- When do people need stem cell transplants?
- Types of stem cell transplants for treating cancer
- Sources of stem cells for transplant
- Allogeneic transplant: The importance of a matched donor
- What’s it like to donate stem cells?
- Getting rid of cancer cells in autologous transplants
- The transplant process
- Problems that may come up shortly after transplant
- After-transplant problems that may show up later
- Other issues related to transplants
- What questions should I ask my doctor before transplant?
- To learn more
What’s it like to donate stem cells?
People usually volunteer to become stem cell donors either because they have a loved one or friend who needs a match or because they want to help people.
If you want to donate stem cells
People who want to donate stem cells or join a volunteer registry can speak with their doctors or contact the National Marrow Donor Program to find the nearest donor center. Potential donors are asked questions to make sure they are healthy enough to donate and don’t pose a risk of infection to the recipient. For more information about donor eligibility guidelines, contact the National Marrow Donor Program or the donor center in your area (see the “To learn more” section for contact information).
A simple blood test is done to learn the potential donor’s HLA type. There may be a one-time, tax-deductible fee of about $75 to $100 for this test. People who join a volunteer donor registry will most likely have their tissue type kept on file until they reach age 60.
Pregnant women who want to donate their baby’s cord blood should make arrangements for it early in the pregnancy, at least before the third trimester. Donation is safe, free, and does not affect the birth process. For more, see the section called “How umbilical cord blood is collected.”
Informed consent and further testing: Before the donation
If a potential stem cell donor is a good match for a recipient, steps are taken to teach the donor about the transplant process and make sure he or she is making an informed decision. If a person decides to donate, a consent form must be signed after the risks of donating are fully discussed. The donor is not pressured take part. It’s always a choice.
If a person decides to donate, a medical exam and blood tests will be done to make sure the donor is in good health.
A couple of pints of blood might also be taken from the donor. This blood is stored in a blood bank and given back to the donor when the stem cells are removed.
How bone marrow stem cells are collected
The donor is put under general anesthesia (given medicine to put them into a deep sleep so they don’t feel pain) while bone marrow is taken. This process is often called bone marrow harvest, and it’s done in an operating room. The marrow cells are taken from the back of the pelvic (hip) bone. A large needle is put through the skin and into the back of the hip bone. It’s pushed through the bone to the center and the thick, liquid marrow is pulled out through the needle. This is repeated several times until enough marrow has been taken out (harvested). The amount taken depends on the donor’s weight. Often, about 10% of the donor’s marrow, or about 2 pints, are collected. This takes about 1 to 2 hours. The body will replace these cells within 4 to 6 weeks. If blood was taken from the donor before the marrow donation, it’s often given back to the donor at this time.
After the bone marrow is harvested, the donor is taken to the recovery room while the anesthesia wears off. The donor may then be taken to a hospital room, and be watched until fully alert and able to eat and drink. In most cases, the donor is free to leave the hospital within a few hours or by the next morning.
The donor may have soreness, bruising, and aching at the back of the hips and lower back for a few days. Over-the-counter acetaminophen (Tylenol®) or non-steroidal anti-inflammatory drugs (such as aspirin, ibuprofen, or naproxen) are helpful. Some people may feel tired or weak, and have trouble walking for a few days. The donor might be told to take iron supplements until the number of red blood cells returns to normal. Most donors are back to their usual schedule in 2 to 3 days. But it may take 2 or 3 weeks before they feel completely back to normal.
There are few risks for donors and serious complications are rare. But bone marrow donation is a surgical procedure. Rare complications could include anesthesia reactions, infection, transfusion reactions (if a blood transfusion of someone else’s blood is needed — this doesn’t happen if you get your own blood), or injury at the needle insertion sites. Problems such as sore throat or nausea may be caused by anesthesia.
Allogeneic stem cell donors do not have to pay for the harvesting because the recipient’s insurance company usually covers the cost.
Once the cells are collected, they are filtered through fine mesh screens. This prevents bone or fat particles from being given to the recipient. For an allogeneic or syngeneic transplant, the cells may be given to the recipient through a vein soon after they are harvested. Sometimes they are frozen, such as when the donor lives far away from the recipient.
How peripheral blood stem cells are collected
For several days before starting the donation process, the donor is given a daily injection (shot) of filgrastim (Neupogen®). This is a growth-factor drug that causes the bone marrow to make and release stem cells into the blood. Neupogen can cause some side effects, the most common being bone pain and headaches. These may be helped by over-the-counter acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (like aspirin or ibuprofen). Nausea, sleeping problems, low-grade (mild) fevers, and tiredness are other possible effects. These go away once the injections are finished and collection is completed.
Blood is removed through a catheter (a thin, flexible plastic tube) that is put in a large vein in the arm or chest. It’s then cycled through a machine that separates the stem cells from the other blood cells. The stem cells are kept while the rest of the blood is returned to the donor. This process is called apheresis. It takes about 2 to 4 hours and is done as an outpatient procedure. Sometimes the process needs to be repeated daily for a few days, until enough stem cells have been collected.
Possible side effects of the procedure can include trouble placing the catheter in the vein, blockage of the catheter, or infection from the catheter. Blood clots are another possible side effect. During the apheresis procedure donors may feel lightheaded or tingling and/or chills from the anti-coagulant drug used to keep the blood from clotting in the machine. These effects go away after donation is complete.
The process of donating cells for yourself (autologous stem cell donation) is pretty much the same as when someone donates them for someone else (allogeneic donation). It’s just that in autologous stem cell donation the donor is also the recipient, giving stem cells for his or her own use later on. For some people, there are a few differences. For instance, sometimes it can be hard to get enough stem cells from a person with cancer. Even after several days of apheresis, there may not be enough for the transplant. This is more likely to be a problem if the patient has had certain kinds of chemo in the past, or if they have an illness that affects their bone marrow.
Sometimes a second drug called plerixafor (Mozobil®) is used along with filgrastim (Neupogen) in people with non-Hodgkin lymphoma or multiple myeloma. This boosts the stem cell numbers in the blood, and helps reduce the number of apheresis sessions needed to get enough stem cells. It may cause nausea, diarrhea, and sometimes, vomiting. There are medicines to help if these symptoms become a problem. The patient should tell the doctor right away if they have any pain in their left shoulder or under their left rib cage; rarely the spleen can get enlarged and even rupture. This can cause severe internal bleeding and requires emergency medical care.
How umbilical cord blood is collected
Parents can donate their newborn’s cord blood to volunteer or public cord blood banks at no cost. This process does not pose any health risk to the infant. Cord blood transplants use blood that would otherwise be thrown away.
After the umbilical cord is clamped and cut, the placenta and umbilical cord are cleaned. The cord blood is put into a sterile container, mixed with a preservative, and frozen until needed.
Remember that if you want to donate or bank (save) your child’s cord blood, you will need to arrange it before the baby is born. Some banks require you to set it up before the 28th week of pregnancy, although others accept later setups. Among other things, you will be asked to answer health questions and sign a consent form.
Many hospitals collect cord blood for donation, which makes it easier for parents to donate. For more about donating your newborn’s cord blood, call 1-800-MARROW2 (1-800-627-7692) or visit Be the Match at www.marrow.org/HELP/Donate_Cord_Blood_Share_Life/index.html
Privately storing a baby’s cord blood for future use is not the same as donating. It’s covered in the section called “Other issues related to stem cell transplants.”
Last Medical Review: 08/23/2012
Last Revised: 10/24/2012