Allogeneic Process

What is it?

The allogeneic stem cell transplant is when your bone marrow and immune system are replaced with new, healthy bone marrow or peripheral blood stem cells from another person. Traditionally, most of the allogeneic stem cell transplants have been performed using stem cells collected from the bone marrow, but the use of peripheral blood stem cells is rapidly increasing.

Indications

Allogeneic transplants (HLA-matched sibling and syngeneic) are available for patients with HLA identical family donors or identical twin donors for the following diseases:

• Severe aplastic anemia or paroxysmal nocturnal hemoglobinuria
• Chronic myelogenous leukemia in chronic or accelerated phase
• Myelodysplastic syndromes
• Myelofibrosis
• Acute myelogenous leukemia, in complete remission, early relapse, or refractory disease
• Acute lymphoblastic leukemia, in complete remission or early relapse
• Relapsed or refractory Hodgkin’s and non-Hodgkin’s lymphomas
• High risk multiple myeloma
• Selected patients with metastatic renal cell cancer and breast cancer will be considered for reduced intensity conditioning “mini-transplant” protocols
• Relapsed chronic lymphocytic leukemia

Who can be a donor?

The best donor for you is usually an individual related by blood (rather than marriage), whose tissue type matches yours as closely as possible. For patients who do not have a family member with matching tissue, it is often possible to find a donor in the general population, through the National Marrow Donor Program (NDMP). Selected patients can also receive stem cells from a mismatched family member (haplo-identical donor).

Transplantation

Once you have completed the pre-transplant therapy and evaluation, and your donor has been cleared for stem cell donation, the actual transplant begins.

Upon arrival on the transplant unit, your nurse will greet you, escort you to your room and obtain a short medical history. Once you have had a chance to settle in, your lab work will be drawn and necessary X-rays will be arranged. If you do not already have a central line, one will be inserted on the day of admission.

Once admitted, you will stay in a HEPA-filtered room with positive air pressure, to decrease the risk of infection. As long as your bone marrow’s function is depressed, you should take all necessary measures to prevent any infection that could compromise your health. For example:

• You should not eat fresh fruits or vegetables, or food from outside the hospital
• You should not have flowers or plants in your room
• You should only drink bottled water

Depending upon your diagnosis, type of donor and the type of transplant, either a combination of total body irradiation (TBI) and chemotherapy or a combination of chemotherapy agents will be administered. Your physician will discuss with you which drugs will be used, and give you a calendar outlining precisely which drugs will be given and when.

Many additional drugs will be administered during the days of radiation and chemotherapy. Some are meant to prevent nausea from chemotherapy, some to prevent infections, others to prevent complications from the chemotherapy drugs. Many of the drugs are given to you by mouth, while some are given to you through your vein. You will also receive lots of fluid through your central line to help cleanse your system as quickly as possible. The day before the stem-cell infusion you will start daily infusions of cyclosporine or tacrolimus. Both of these drugs are used to help prevent severe graft-versus-host disease and transplant rejection.

Some patients choose to be admitted to the CTCA Stem Cell Transplant Unit at the start of the conditioning regimen but an increasing number of people choose to do this part of the process as an outpatient.

Two days after finishing the conditioning regimen, the stem cells will be infused via your central line much like a blood transfusion. This infusion rarely causes any side effects. After the infusion of stem cells, we will wait for the growth of the new blood cells. It takes about two to three weeks before the first white cells re-appear. In the meantime, the "old" blood cells start dying off, and you may become prone to infections and bleeding. Patients typically will need multiple transfusions of platelets and red cells during this growth period. Once the white cells and platelets re-appear, they slowly return to the normal range. Transfusions are usually only needed for the first 4-8 weeks after transplant.

As a patient in the transplant unit, you will be able to participate in your care as much as possible. It will be very important for you to shower daily, maintain a balanced diet and keep active through physical therapy and short walks.