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How you prepare
By Mayo Clinic staffPre-transplant tests and procedures
Once donor stem cells become available, you undergo many tests and procedures to assess your health and the status of your condition, and to ensure that you're physically prepared for the transplant.
In addition, an intravenous (IV) catheter is typically surgically implanted, usually in your chest near your neck. This is often called a central line, and it usually remains in place for the duration of your treatment. It's through the central line that the transplanted stem cells will be infused. The central line is also used to collect blood samples, give chemotherapy, provide blood transfusions and even supply nutrition when necessary.
The conditioning process
After you complete your pre-transplant tests and procedures, you begin a process known as conditioning. During conditioning, you undergo chemotherapy and possibly radiation in order to:
- Destroy cancer cells
- Suppress your immune system so that your body doesn't reject the transplanted stem cells
The type of conditioning process you undergo depends on a number of factors, including your disease, overall health and the type of transplant planned — whether you get stem cells donated from someone else (allogenic transplant) or whether the stem cells come from your own body (autologous transplant).
Conditioning generally occurs in the week leading up to your stem cell transplant. In some cases, you receive high doses of chemotherapy and total body irradiation (TBI). On the other hand, you may receive only high doses of chemotherapy and no radiation at all. The type of conditioning you undergo depends on your unique circumstances.
The conditioning process may be done in the hospital or on an outpatient basis. It can cause numerous side effects and complications because your bone marrow and stem cells are destroyed in anticipation of the transplant, and even if your conditioning process is outpatient, you may need hospitalization for side effects.
Side effects of the conditioning process can include:
- Nausea and vomiting
- Diarrhea
- Hair loss
- Mouth sores or ulcers
- Infections, such as pneumonia
- Bleeding
- Infertility or sterility
- Premature menopause
- Anemia
- Fatigue
- Cataracts
- Organ failure, such as heart, liver or lung failure
- Secondary cancers
You may be able to take medications or other measures to reduce such side effects.
'Mini' stem cell transplants
A less intense conditioning process is available through what's known as a mini stem cell transplant. It's also called a reduced-intensity conditioning transplant or a nonmyeloablative transplant.
Reduced-intensity conditioning doesn't try to kill all of the cancer cells that may be in your body. Instead, it relies on the donor's immune system cells to fight your cancer cells.
A less intense conditioning regimen may seem attractive because it may pose fewer life-threatening complications. But this kind of transplant isn't appropriate for all situations. Mini stem cell transplants are typically used only for people who can't endure the harsher conditioning regimen, such as people in poorer health, and for people whose disease isn't rapidly progressing. In some cases, they may not be as successful as full transplants.
