What is a Stem Cell Transplant?
There are many diseases which are nowadays being cured by stem cells. But what actually are “stem cells”? These are basically the precursor cells which mature into different types of blood cells, namely, red blood cells, white blood cells, and platelets.
There is also another term – “bone marrow transplant”. there are two main sources of obtaining stem cells in adults. These are bone marrow and peripheral blood. When these cells are obtained from the bone marrow, we call it a bone marrow transplant. When the cells are taken from the circulating blood, the procedure is known as the “hematopoietic stem cell transplant”.
How does a Stem Cell Transplant cure a disease?
In this procedure, the patient receives healthy blood-forming cells to replace the defective ones. The patient’s stem cells can become defective or non-functional either due to a disease or radiation.
The newly inserted cells perform the function of duplication as well as growth and development of the blood cells. This helps in compensating for any decrease and loss of these cells due to any reason. As a result, the body can return back to its normal state.
How are the Cells obtained?
As we have seen, when we say Haematopoietic Stem cell Transplant, we mean the stem cells which are obtained from the peripheral blood. Weeks before the procedure, the patient is given various “growth factors” to stimulate the production of these blood-forming cells in bone marrow and move into circulation faster.
To extract the cells, an intravenous or IV tube is inserted in the donor’s arm. It is attached to a machine which performs the function of separating the stem cells from the blood and then collecting it. The rest of the blood is then sent back into the body via the same IV. The process may take a few hours and sometimes more than one sitting.
What are different types of Stem Cell Transplants?
Depending upon the source of stem cells, we can obtain the cells based upon who gives them. Mainly, it of three types i.e. allogenic stem cell transplant, autologous stem cell transplant, and syngeneic transplants.
An “Autologous transplant” means that the cells are used from the patient’s own blood. In some cases, the stem cells are collected for two transplants. When a patient has to be given high dose Chemotherapy, the second dose of the cells is transplanted usually 6 weeks after the first.
In an “Allogenic Transplant”, the cells are obtained from a donor after proper matching. The donor may or may not be related to the patient.
Then comes the “Syngeneic transplant”. The procedure obtains the cells from an identical twin. An identical twin has the same set of antigens and there are minimal chances of rejection.
What needs to be kept in mind for a Stem Cell Transplant?
Stem cell transplant is not a regular day-to-day procedure. It needs to be meticulously planned by a specialized team consisting of hematologists, general physicians, oncologists, immunologists etc. Along with all this, a careful patient examination is necessary. The patient should be able to handle the treatment. Some of the commonly considered patient factors are age (the younger the better because of better recovery); patient’s overall health and allied medical conditions; the, of course, the type, severity, prognosis, and spread of cancer. Also, the type of chemotherapy and the chances of cancer for remission or relapse also affect the treatment plan.
What are the possible Risks of Stem Cell Transplant?
The problems range from common nausea and vomiting to the more severe “Graft vs Host Disease (GVD)”. Some of the usual side effects include nausea/vomiting; infections; mucositis and pneumonitis. Patients may also need transfusions due to continuous bleeding before the effects of transplanted cells kick in.
Meticulous precautions should be taken post-operatively to prevent infections. We cannot predict how drained out the patient is after the chemotherapies after which he/she receives the transplant. Proper diet and necessary infection control measures need to be taken. The patients are also given precautionary antibiotics to prevent the development of infections.
Now we can address the major problem:
Graft vs Host Disease. It happens in allogenic transplant cases where the patient rejects the donor cells after the transplant. It is an emergent and critical complication which needs to addressed immediately. It can either be acute or chronic. Acute GVD shows its signs within 10-90 days of the stem cell transplant. While a chronic GVD later and lasts for a long time. In order to prevent such conditions, doctors prescribe immunosuppressants to lower down the chances of rejections.
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