Blood and Marrow Transplant

The Scripps Blood and Marrow Transplant Program uses peripheral blood stem cell collection. Before this procedure, the donor receives daily injections of a medication that moves stem cells out of the bone marrow and into the blood.

On the day of the procedure, the donor is connected to a blood collection and processing machine through a needle inserted into their arm. As blood moves into the machine, it is filtered to collect only the stem cells, and the remaining blood is returned back to the donor through a needle in their other arm.

Peripheral blood stem cell collection takes several hours. The donor can go home the same day and resume normal activities almost immediately. Full recovery may take a week.

Because the procedure takes place under general anesthesia, there is no pain during the donation itself. All surgical procedures involving general anesthesia have risks, which will be thoroughly reviewed by the transplant team before the donor gives final consent for the donation.

Afterward, there may be discomfort at the site where the needle was inserted in the donor’s bone, but this discomfort goes away within a few days. The donor’s body naturally replenishes its supply of bone marrow in about two to three weeks.

Stem cells, also called pluripotent stem cells, are immature blood cells that develop into red blood cells, white blood cells and platelets. Each of these plays a vital role in your health. Red blood cells carry oxygen and nutrients throughout your body, white blood cells help fight infection and platelets help with blood clotting. Stem cells are found mostly in your bone marrow as well as in your blood.

A stem cell transplant is a procedure that infuses healthy stem cells into a person’s blood to replace cells damaged by diseases, such as cancer, or by treatments, such as chemotherapy, and rebuild their immune system to fight disease. The healthy stem cells develop and reproduce, creating new red blood cells, white blood cells and platelets.

In an autologous transplant, patients receive their own stem cells, which are removed from their blood or bone marrow before they receive high-dose chemotherapy or radiation treatment. The stem cells are then stored for later use.

In an allogeneic transplant, patients receive stem cells from a donor. The closer the donor’s stem cells are to your own, the lower the risk that the new stem cells will be rejected by the recipient’s body (called graft versus host disease).

Special blood tests are done to determine if a donor’s stem cells are a good match for the recipient. While a first-degree relative, such as a parent, child or sibling is usually the best match, many patients do not have a family member who meets the donation criteria. In this case, a matched unrelated donor (MUD) may be found through registries such as the National Marrow Donor Program.

Before the new stem cells are transplanted, you will receive chemotherapy to help destroy your diseased cells and make space inside your bones for the new stem cells. In most cases, after a couple of weeks the healthy stem cells will be placed into your body through an intravenous (IV) catheter; the cells will then move into the space inside your bones and begin to produce new cells.

It may take you several weeks to several months to recover after a stem cell transplant. You may need to stay in or near the hospital for three months or more to allow your medical team to monitor your recovery and address any side effects or complications. You will continue to recover at home. 

Because your immune system is building itself back up during recovery, you will need to be especially careful about avoiding infection. Your team will want you to rest and regain your strength in a clean, low-stress environment where you will not come into contact with large groups of people. If you receive stem cells from a donor, your recovery may take longer. Your physician will determine when you can return to work and resume other activities.

During CAR T-cell therapy, the patient’s T cells are collected from the blood using apheresis, a procedure which removes some components of blood and returns the remaining blood to the patient’s body. Scientists genetically modify the T cells so that they make a type of protein called a receptor. The receptor recognizes a type of protein called an antigen that is found on the surface of cancer cells. The modified T cells are multiplied and pumped back into the patient’s blood, where they can recognize and attack cancer cells. The modified T cells are multiplied by the hundreds of millions and then infused back into the patient to fight the disease.

After the T cells are collected through apheresis, it usually takes a few weeks to modify and multiply the cells. Most patients will stay in the hospital during this time, and may have a short course of chemotherapy to weaken their immune system and help the modified T cells do their job. Following the T-cell infusion, patients spend a few more days in the hospital, and generally stay close to the hospital for several weeks to monitor and treat any side effects.