Prior to Procedure

The donor will be carefully tested to check for communicable disease. Both the donor and the recipient will be tested to ensure that their tissues are compatible. In order for stem cell transplant to be successful, certain markers (called HLA types) on the donor's and recipient's blood cells and bone [2] marrow cells must match.

The recipient will be given medications to suppress the immune [12] system, and therefore prevent the body from rejecting the donor stem cells. In the weeks prior to the stem cell transplant, the recipient may undergo intense chemotherapy and/or radiation therapy. This process rids the body of diseased cells and to clear the bone [2] marrow cavities for the new bone [2] marrow. This process is called "conditioning."

During Procedure

For the BMT, removal of bone [2] marrow from the donor, called "harvesting," takes place in an operating room. The donor receives sedation, anesthesia, and perhaps intravenous fluids. For the PBSC, removal of blood with stem cells is obtained through a needle stick in the vein of the donor's arm. The recipient receives the blood-forming cells (stem cells) in an isolation room, and may require fluids and anti-nausea medications during administration.

Anesthesia

• Donor— General anesthesia [13] (if BMT) or none (if PBSC harvesting)
• Recipient—None

Description of the Procedure

After Procedure

The donor will recover quickly. The recipient will need to be placed in isolation to avoid infection until their new blood-forming cells (stem cells) in the bone [2] marrow begins to produce infection-fighting cells.

How Long Will It Take?

• Donor—About 30 minutes if BMT or several hours if PBSC
• Recipient—Several hours

Will It Hurt?

• Donor—For BMT, anesthesia prevents pain [14] during the procedure. You may have some pain [14] or discomfort in the area where the bone [2] marrow was removed, but pain [14] medication may be given to relieve pain [14] and soreness during recovery. For PBSC, the needle sticks cause a small amount of pain [14].
• Recipient—You won't feel any pain [14] while the stem cells are infused. You may have some nausea, which can be treated with medication.

Possible Complications

Donor

• Bleeding
• Infection

Recipient

• Infection during the period when the original blood-forming cells in the bone [2] marrow is being destroyed via chemotherapy and/or radiation, and before the donor blood-forming cells multiply and then begin to function
• Rejection of donor blood-forming cells (stem cells)
• Acute graft versus host disease, which occurs when the immune [12] cells in the donor's bone [2] marrow attack the recipient's tissues

Average Hospital Stay

• Donor—Overnight if BMT. Several donations, each lasting a couple of hours, if PBSC.
• Recipient—1-2 months

Postoperative Care

Donor

• Pain medication and antibiotics to prevent infection

Recipient

• Immunosuppressant medications to decrease the chance of transplant rejection
• Antibiotics to prevent infection
• Platelets, plasma, and red blood cell transfusions to prevent bleeding and anemia
• Frequent blood tests to monitor whether the new stem cells in the bone [2] marrow is taking hold or being rejected