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Types of BMT and Stem Cell Transplants

Blood and marrow transplants have improved tremendously over the years, and Hollings is proud to have been – and to continue to be – part of the research effort into making this type of treatment more effective and available to more patients.

Stem cells grow in the bone marrow and eventually become different types of blood cells. When someone has cancer or another disease that is causing abnormal stem cells to develop, doctors can use chemotherapy to kill off the abnormal cells and then infuse healthy stem cells into the body. In most cases, those new, healthy stem cells will engraft, or travel to the bone marrow where they take root and begin producing healthy blood cells.

There are several ways that doctors can perform blood and marrow transplants. The method chosen will depend on the specific medical condition, the availability of donors and the overall health of the patient. Your doctor can talk with you in more detail about which option is best for your situation.

Autologous Transplants

Autologous blood or marrow transplant uses some of the patient’s own stem cells which can be frozen and stored for later use. The cells are used to “rescue” the bone marrow after high dose chemotherapy or radiation is administered to treat the patient’s condition.

Because these are your own cells, your immune system should not reject them.

Allogeneic Transplants

Allogeneic blood or marrow transplant replaces damaged bone marrow with healthy marrow from a donor.

If possible, it’s preferable to use a donor who is a “full match.” This is when all of the donor’s human leukocyte antigens (HLA) – proteins on the body’s cells – match the patient’s.

Full siblings have a 25% (1 in 4) chance of being a perfect match for a recipient. In some cases, no one in the family will be a perfect match for the patient. Unrelated donors from the National Marrow Donor Program's registry will be searched and may be a potential match for the patient.

If a perfectly matched donor is not available, alternative transplant options may be considered.

Allogeneic Transplant Options

A partial match is when a donor matches the majority – but not all – of the patient’s HLAs.

A haploidentical match is when half of the donor’s HLAs match the patient’s.

MUSC was part of the original multi-center trial that changed the trajectory of transplant by showing that half-matched transplants could be successful for people with leukemia and lymphoma. Thanks to this trial, it is possible for almost all patients to have a donor.

Syngeneic blood or marrow transplant uses an identical twin's stem cells for the patient’s transplant.

Cord blood from a sibling or an unrelated donor can be used but must also be human leukocyte antigen (HLA)-matched to improve the chances of a successful transplant. This type of transplant is usually most successful in patients who are small (typically children) due to the small amount of stem cells available in the cord.

Becoming a Stem Cell Donor

Donating stem cells is a lifesaving act. By joining the donor registry, you are potentially giving another person the gift of more quality time with family.

Lifelong Connection

Two strangers share an unusual blood connection - a connection that saved one's life and brought the other a best friend 40 years his senior.

Methods of Stem Cell Donation

Peripheral blood stem cell (PBSC) donation is a non-invasive method of removing stem cells from the bloodstream. It is the most common way to donate stem cells. NMDP reports that 90% of donations are through the peripheral blood stem cell method.

Prior to the PBSC donation, donors receive daily injections of filgrastim for four to five days. Filgrastim (also called G-CSF or Neupogen) is a manmade version of protein that occurs naturally in the body. It causes blood stem cells to move out of the bone marrow into the bloodstream. This medication is usually well-tolerated but typically causes mild discomfort in the donor. Side effects of this medication may include but are not limited to: bone pain, fatigue, trouble sleeping, headaches, abdominal pain, nausea or vomiting.

During the stem cell donation, the donor has an IV (needle) inserted into each arm. Blood passes through one of the needles into a tube that is connected to an apheresis machine. This machine removes the stem cells and returns the remaining blood back to the donor via a tube connected to the needle in the other arm. The procedure takes about five hours and two sessions (or two days of donation) may be required.

Donors typically recover from this type of donation and are able to return to full normal activity in 1 to 2 days.

The procedure to collect donated bone marrow is called a bone marrow harvest. This is a surgical procedure that takes place in the operating room. During the procedure, the donor is given anesthesia so they will not feel pain. Once the donor is anesthetized, the surgeon removes bone marrow using a sterile needle that is inserted into the donor’s rear hip bones. He or she extracts the bone marrow – a thick red liquid – and places it into a bag for the recipient. The harvested bone marrow, containing the life-saving stem cells, is then processed to remove impurities before being administered to the recipient.

While the donor may have several skin punctures during the harvest, there are no surgical incisions requiring stitches. After the harvest, a sterile dressing is applied and the donor is moved to a recovery area where he or she can be closely monitored until the anesthesia wears off. The donor may return home that day or stay overnight in the hospital if necessary.

Following the harvest, donors may feel pain or soreness in their lower back for several days. This can be controlled with over-the-counter pain medications or for moderate pain, a prescription may be given. Most donors will feel fatigued for several days after the harvest and are able to resume normal activities within a week.