Stem Cell Transplant (Peripheral Blood, Bone Marrow, and Cord Blood Transplants)

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Why would someone need a stem cell transplant?

Stem cell transplants are used to replace bone marrow that isn’t working or has been destroyed by disease, chemo, or radiation. In some diseases, like leukemia, aplastic anemia, certain inherited blood diseases, and some diseases of the immune system, the stem cells in the bone marrow don’t work the way they should.

Damaged or diseased stem cells can make too few blood cells, too few immune cells, or too many abnormal cells. Any of these problems can cause the body to not have enough normal red blood cells, white blood cells, or platelets. A stem cell transplant may help correct these problems.

In some cancers, such as certain leukemias, multiple myeloma, and some lymphomas, a stem cell transplant can be an important part of treatment. It works like this: high doses of chemo, which is sometimes given with radiation, work better than standard doses to kill cancer cells. But high doses can also cause the bone marrow to completely stop making blood cells, which we need to live. This is where stem cell transplants come in. The transplanted cells replace the body’s source of blood cells after the bone marrow and its stem cells have been destroyed by the treatment. This transplant lets doctors use much higher doses of chemo to try to kill all of the cancer cells.

A stem cell transplant from another person can also help treat certain types of cancer in a way other than just replacing stem cells. Donated cells can often find and kill cancer cells better than the immune cells of the person who had the cancer ever could. This is called the “graft-versus-cancer” or “graft-versus-leukemia” effect. It means that certain kinds of transplants actually help fight the cancer cells, rather than simply replacing the blood cells.

Thinking about a stem cell transplant

It’s a tough decision. Although a stem cell transplant can help some patients, even giving some cancer patients a chance for a cure, making up your mind to have a transplant isn’t easy. Like everything in medicine, you make the final choice as to whether or not you’ll have a stem cell transplant. Your cancer care team compares the risks linked with the cancer itself versus the risks of the transplant procedure, and will discuss the expected risks and benefits with you. They may also talk with you about other options like chemotherapy, radiation, or clinical trials for your disease. Transplants have serious risks, and patients can die from complications. The stage of the disease, patient’s age, time from diagnosis to transplant, donor type, and the patient’s overall health are all part of weighing the pros and cons before making the decision.

You’ll want to ask a lot of questions to be sure you understand what’s likely to happen. Some people bring a friend or family member to help them remember what the doctor or transplant team says, remind them of questions they had, and take notes. Some people prefer to record these conversations, if the doctor or nurse is OK with that and agrees to it.

Be sure to express your concerns and ask for clarification if you aren’t sure how something will affect you. Make sure the doctor knows what’s important to you, too. This is a complicated process, and you’ll want to find out as much as you can and plan ahead before you start.

Many people ask for a second opinion before they decide to have a stem cell transplant. It’s important to know about the success rate of the planned transplant based on your diagnosis and your stage in treatment. In general, transplants tend to work better if they’re done in early stages of disease or when you are in remission, when your overall health is good. Ask about these factors and how they affect the expected outcomes of your transplant or other treatment.

Also, call your health insurance company to ask about reimbursement for a second opinion before you go. You might also want to talk with them about your possible transplant, and ask which transplant centers are covered under your insurance. See also “Cost of transplant” in the section “Other transplant issues.”

Last Medical Review: 10/02/2013
Last Revised: 10/02/2013