adult blood
and marrow
stem cell
transplant


Depending on the type of disease to be treated, a patient can receive stem cells either from their own blood or from a donor.  An autologous transplant involves removing the patient's own stem cells which are then processed for re-infusion. In an allogeneic transplant, the patient receives stem cells from a related (family member) an unrelated (non family member) matched or mismatched donor, or an umbilical cord blood donation. Unrelated donors are usually found through the National Marrow Donor Program (NMDP) and other national marrow registries. Because donated stem cells must match the patient's tissue type as closely as possible, the waiting period can be several months. While waiting, the recipient must follow the physician's orders and be evaluated periodically.

Types of Transplants

The transplant physician will discuss with the patient which type of transplant will provide the best clinical outcome.  The following types of transplants are performed routinely at Methodist Hospital by the Texas Transplant Institute Blood and Marrow Stem Cell Transplant physicians:

Autologous stem cell transplant - stem cells that are collected, stored and re-infused back to the same patient after high-dose chemotherapy and/or radiation treatments.

Tandem autologous transplant - also known as a double autologous transplant requires the patient to undergo two planned autologous stem cell transplants within 6 months. Stem cells are collected once before the initial transplant and half are used for each procedure. The second transplant is performed after recovery from the first procedure.

Allogeneic stem cell transplant - - stem cells that are taken from one person and given to another. The patient receives stem cells from a matched or partially matched family member, an unrelated donor, or umbilical cord blood.

Umbilical cord blood transplant – utilize stem cells which have been collected from a clamped, separated umbilical cord following delivery.  The stem cells are then processed and frozen until transplantation. 

Patient Transplant Expectations

The first step in the transplantation process begins with a referral to the Texas Transplant Institute by the prospective patient's physician. The transplant financial coordinator verifies transplant insurance benefits and begins creating a financial plan regarding all transplant services. The clinic will then contact the patient and the referring physician's office to discuss expectations and schedule an appointment for a pre-transplant evaluation.

During the initial clinic visit, the patient meets with the transplant physician, nurse, social worker and coordinator. At this visit, the transplant team reviews the patient's medical records sent by the referring physician, the transplant physician's assessment, and diagnostic test results. The patient, referring physician, and insurance company are then given the recommendations made by the transplant team.

Completing the evaluation usually takes a few weeks. The Texas Transplant Institute is committed to working with the patient at a comfortable pace throughout the evaluation process.   The length of time waiting for a transplant also depends upon whether an autologous or allogeneic donation will be used.

For an autologous donation, the patient will undergo a stem cell collection two to four weeks prior to the actual transplant.  If waiting for an allogeneic donor to be identified, the patient will be followed by their referring physician as well as the transplant staff. Once an acceptable match becomes available, the patient will be contacted and given specific instructions. The patient will undergo pre-transplant testing and receive a physical examination by the transplant physicians to ensure their medical condition is still suitable to receive the transplant.

Several days prior to the procedure, the patient receives high doses of chemotherapy and/or radiation in preparation for the transplant.  The transplant is similar to a blood infusion and lasts ten minutes to three hours, depending on how many and what type cells are transplanted.

Most transplant patients should expect to be hospitalized at some point during the process.  The length of stay will vary based on the type of transplant and the patient’s condition.  The transplant physician will decide if the transplant will occur in the hospital or in the transplant clinic. 

It is normal for the patient to experience severe flu-like symptoms right before and right after the transplant.  These symptoms include nausea, vomiting, diarrhea, fever, and extreme weakness.

Private insurance, as well as Medicare and Medicaid, may provide coverage for blood or marrow stem cell transplants. However, the costs may not be fully reimbursed. The Texas Transplant Institute coordinates benefits with social agencies and other potential funding sources to help finance transplants. Our transplant coordinators can assist the patient with information and planning.

The Texas Transplant Institute also works closely with local support groups to help transplant patients prepare for the procedure. In addition, the hospital's Oncology Support Team and Caregiver Support Group provide weekly education and support sessions to patients and their families.

Our medical, social, and financial specialists are always available to answer questions and provide assistance regarding transplantation.

Donor Expectations

Stem cells, which are found in bone marrow and circulating blood, are obtained from "matched" and "unmatched" donors. Eligibility requirements are the same for both related and unrelated donors. Donors must be in good health and undergo a thorough medical evaluation.

A related donor is usually a brother or sister. However, related donors do not always match perfectly with the recipient. For selected diseases, mismatched donor-related transplants may provide an alternative to waiting several months on a national unrelated donor registry. Mismatched donor-related transplants are performed based on the recipient's clinical condition as well as disease state.

Unrelated marrow or stem cell donors are individuals who have voluntarily registered with the National Marrow Donor Program. The donor must complete a health questionnaire and undergo an initial blood test to determine eligibility. If eligibility criteria are met, the donor is then registered with the NMDP. In the event of a potential match, another blood test will be conducted to further evaluate donor-recipient compatibility. The donor will also attend educational sessions regarding bone marrow and stem cell collecting procedures, risks, and expectations. Once the donor consents to the procedure, arrangements will be made for the stem cell collection.

Stem cells are collected from either a bone marrow or peripheral blood stem cell harvest. Bone marrow harvests are performed in the operating room under anesthesia. In this process, cells are usually removed from the back of the hips by inserting needles into the bone marrow cavity and aspirating the cells. The procedure typically lasts 45 minutes. The stem cells are then processed and either immediately transfused into the recipient or frozen and placed in storage. Following bone marrow harvest, donors may experience bone pain for few days to two weeks.

A peripheral blood stem cell harvest involves the administration of growth factors several days before the collection. The growth factors increase stem cell production, moving the cells into the bloodstream. Stem cells are then harvested from the blood using a special cell-separating machine connected to the donor intravenously. This process consists of one to three separate collections performed as an outpatient, lasting approximately three to five hours per collection.

Donors typically can return to normal activities within a few days. The entire cost of the evaluation, donation and follow-up care usually is paid by the recipient's health insurance. The transplant specialists at Texas Transplant Institute will review the financial aspects, specific to each patient and donor, with both individuals so that there is an understanding of the insurance benefits.

Unrelated donor transplants have become more successful with the advancement of better tissue matching procedures, alternative sources for bone marrow and stem cell collection, and improved methods for reducing graft rejection.

With a shortage of donors available for transplantation, sharing one’s life can make a remarkable difference for a loved one, a friend, or a complete stranger.  The transplant coordinators at the Texas Transplant Institute are always available to provide information regarding bone marrow and stem cell donations.