This booklet has been written to help you, your family and friends understand more about stem cell and bone marrow transplants.
If your doctor has told you that a transplant may be a possible option for you, we hope that this booklet will help you understand what it involves. We hope that the booklet will help you to prepare yourself and that it will answer some of your questions about this treatment - why it may or may not be recommended for you, what the procedures are, the side effects you may experience, and the precautions you will have to take during and after your stay in hospital.
The idea of a transplant can be frightening. It is an intensive procedure which may be stressful both for the person having it and for the people close to him or her. We hope that, by reading this booklet, you will feel better informed and therefore more confident about the treatment you are having.
If you are a parent whose child is to have a transplant, we hope you will find this booklet helpful in explaining the procedures. There is a short section in the chapter "Bone marrow transplants in children" about children and transplants. Further help and information are available from the organisations listed.
Stem cell and bone marrow
transplantations are types of intensive treatment used to treat certain cancers,
particularly leukaemias and lymphomas, some other cancers and also some
non-cancerous diseases of the bone marrow.
Transplants are a way of allowing much higher doses of chemotherapy
to be given, to improve the chances of completely curing the disease. Very high
doses of chemotherapy, with or without radiotherapy,
are given over a few days, and stem cells or bone marrow (either your own, or
donated by someone else) are then given back to `rescue' you from the effects of
the high dose treatment.
Transplants need to be carried out by specialist teams at
specialised cancer treatment centres. If you do have a transplant, you may have
to be treated in a hospital some distance from your home.
Although these procedures are often loosely called
transplants, strictly speaking only situations where stem cells and bone marrow
are taken from someone else are actually `transplants'. It is more common for
the stem cells or bone marrow to be taken from the individual and given back to
them - this is not a transplant, and is more accurately called a `rescue.'
Not everyone with cancer will be suitable for a transplant or
rescue or would benefit from one.
Bone marrow is found inside the bones, particularly the pelvic bones. It
is the `factory' for the blood, responsible for producing white blood cells (to
protect against infection), red blood cells (to carry oxygen round the body) and
platelets (to prevent bleeding).
Stem cells are blood cells at their very earliest stage of development
in the bone marrow, before they have become committed to developing into white
cells, red cells or platelets. It is these cells which are the key factor in
transplants, whether just the stem cells are transplanted or the bone marrow
itself (which naturally includes many stem cells).
How are stem cells obtained?
Stem cells can either be obtained directly from the bone marrow (which involves
a general anaesthetic). Or, they can be encouraged to increase in the bone
marrow and spill over into the blood in different ways (peripheral blood stem
cells). They can then be collected directly from the blood.
This is usually done by giving doses of chemotherapy
drugs, which will damp down bone marrow activity and temporarily reduce the
number of stem cells in the bone marrow. When the bone marrow is recovering from
the chemotherapy, the stem cells rapidly increase. This process is encouraged by
the injection of special proteins called growth factors, and when the stem cells
spill over they can be collected from the blood rather than the bone marrow.
Sometimes stem cells can be induced to spill over into the blood by the use of
growth factors alone.
The stem cells are given back after the high-dose treatment
and go on to form healthy, mature blood cells.
The way in which the stem cells are collected (from the bone
marrow or the blood) depends on a number of factors, including your type of
cancer. Your doctor will explain fully the method that will be best for you.
Stem cell collection from the blood has a number of
advantages. You do not need to have a general anaesthetic. The time taken for
the marrow to recover after the treatment is shorter than with a marrow
transplant, and the period during which you are at risk of infection is
therefore shorter.