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Allogeneic Stem Cell Transplant at Yale

An allogeneic stem cell transplant involves receiving stem cells from another person (a donor). The transplant process is made up of three stages: pre-transplant, during transplant and post-transplant. The National Marrow Donor Program (NMDP), created in 1986, is a non-profit organization that assists with unrelated donor stem cell transplants for patients around the world with life-threatening blood diseases who do not have matching donors in their families.

Pre-transplant: Initially, there is a search for a compatible donor. This is done through a blood test called HLA testing. Immediate family members are tested until a match is obtained. If one of your family members is a match, he or she will undergo the process of donating their stem cells. If there is no match within family members, then a search is performed for an unrelated donor. When a donor is found, he or she undergoes a process to collect their stem cells. The stem cells may be collected through the blood or the bone marrow. In preparation for your admission, you will have several blood
tests and radiological exams. You will also need to have some type of central venous catheter present through your entire admission and even after your discharge. If you already have a catheter, it may still be necessary to get a second one. Your physician will determine this.

During transplant: You will be admitted to the Transplant Unit on a specific day chosen by your physician. Depending on the type of transplant you receive, your hospitalization will be three to six weeks in length. The first six to ten days of your hospitalization will consist of chemotherapy with or without radiation therapy, depending on your treatment regimen. After your treatment regimen is complete, you will receive your donor’s stem cells.

Post-transplant: After your stem cell reinfusion, your body will slowly begin to recognize your donor’s cells. It is during this time that you will begin to develop your new immune system. Your physicians and nurses will monitor you for signs and symptoms of engraftment (when new cells are seen in your blood). This occurs when your white blood cells and platelets are returning to normal. On average, you will engraft 10−14 days after your reinfusion. At the same time, your physician will be monitoring you for signs of graft-versus-host disease (a possible complication caused by the activity of the donors immune system). You will be assessed frequently and given the necessary treatments to maintain your body’s daily needs. Several things will be evaluated to determine when you will be ready to go home. When you are discharged from the hospital you will need to be seen by your transplant doctor. For the first one hundred days you will be monitored closely. This usually entails daily to weekly visits, which may include: blood tests, radiology exams, physical exams, blood and platelet transfusions, electrolyte infusions, intravenous hydration and medication review. As your symptoms lessen, your frequency of visits will also lessen. After the first one hundred days have passed; your visits will become dependent on any symptoms you may experience. Your physician will determine all visits and visit schedules at the appropriate times.