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Stem cells can develop into many cell types and act as the body’s repair system. They replace or restore damaged tissues, offering new possibilities for treating diseases.
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The stem cell transplant process is a carefully orchestrated sequence of medical events, often spanning several months. It is not a single surgical event but a continuum of care that transforms the patient’s physiology. The procedure is generally divided into distinct phases: mobilization/harvesting, conditioning, infusion, and the immediate post-transplant neutropenic phase. Each stage uses precise protocols to maximize the regenerative potential of stem cells while managing treatment toxicity.
The first step is to collect hematopoietic stem cells. The method depends on the source and type of transplant.
Conditioning is the “heavy lifting” phase of the transplant. It serves three vital purposes: to destroy any remaining cancer cells, to suppress the patient’s immune system so it does not reject the donor cells, and to create physical space in the bone marrow for the new cells to take up residence.
The day of the transplant is often called “Day 0” and is celebrated as a “second birthday.” Despite the buildup, the infusion itself is anticlimactic and simple.
Following the infusion, the patient enters the “nadir,” a period where blood counts drop to near zero before the new cells start working. This is the most dangerous phase.
In allogeneic transplants, preventing the donor cells from attacking the patient’s healthy tissues is a priority. Patients receive immunosuppressive drugs, such as tacrolimus, cyclosporine, or methotrexate, starting before or immediately after the transplant. These drugs dampen the immune response, allowing the new immune system to acclimate to its new host environment without causing severe damage to the skin, liver, or gut.
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No, the infusion itself is painless. It feels similar to receiving a blood transfusion or saline drip. However, if the stem cells were frozen with the preservative DMSO, you might experience temporary side effects such as a strange taste in your mouth, flushing, or nausea, which can be managed with medication.
The conditioning regimen typically lasts 5-7 days, ending a day or two before the stem cell infusion. The duration and intensity depend on the specific protocol chosen for your disease and overall health.
Engraftment is the milestone when the transplanted stem cells settle into the bone marrow and start producing new blood cells. Doctors confirm this by monitoring daily blood tests. When the neutrophil count (a type of white blood cell) rises consistently for three days in a row, engraftment is officially declared.
A central venous catheter (like a Hickman or PICC line) is essential because the chemotherapy drugs are too potent for small arm veins and would cause damage. The central line also allows painless blood draws, stem cell infusions, and the simultaneous administration of multiple medications and blood products without repeated needle sticks.
Yes, although rare, graft failure can occur. Primary graft failure happens when the new cells never start producing blood. Secondary graft failure occurs when the cells initially work but then stop. Causes include viral infections, drug toxicity, or residual immune rejection. In such cases, a second infusion of stem cells or a second transplant may be attempted.
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