Treatment Stem cell transplant for aplastic anaemia What is a stem cell transplant? Aplastic anaemia is a disease in which the bone marrow’s stem cells are damaged and do not make enough blood cells (red and white blood cells and platelets, all of which perform their own functions). Therefore for some patients, a stem cell transplant may be the best long-term solution. A stem cell transplant is a process in which healthy stem cells from a donor are infused into your bloodstream. These will ultimately make their way to your bone marrow and start to make new stem cells. These stem cells will develop into red and white blood cells and platelets.Determining whether a stem cell transplant is right for you will depend on various criteria, such as your response to treatment so far, your age, other underlying health conditions, the availability of a wellmatched donor and, most importantly, that you have agreed to this. Once you and your medical team have decided that this is the correct option for you, then your stem cell transplant can go ahead. The exact timing of the start of your transplant will depend on factors such as when your donor is available. This can take some time, and your medical team will discuss this with you. Who will my stem cell donor be? For a transplant to take place, a donor is needed whose tissue type matches your own, and who has been thoroughly tested and screened. Siblings can be tested, as they have a good chance (one in four) of being a perfect match for you, but it is likely that your donor will be somebody that you do not know. This is called a matched unrelated donor (MUD). Before your stem cell transplant You will meet with your transplant team, who will discuss the process with you in detail, and you will sign a consent form. You will need various tests before the transplant so these will be arranged. It is advised that you spend some time preparing yourself for both the transplant itself and the inevitable longer term effects that it will have on your life. Most people need several months before they are able to return to work, and will not be able to undertake full parenting or caring duties for some time, so forward planning will be required. If you can maintain a healthy lifestyle when preparing for your transplant, this provides a great starting point for your recovery. Try to eat healthy, nutrition-rich food, and exercise when you can. This does not have to be a strenuous workout – just taking a gentle walk or a swim can help both your physical and mental wellbeing. Conditioning therapy To prepare your body for new stem cells, you will need to have a treatment called ‘conditioning therapy’, which will last around a week. This is a combination of chemotherapy drugs, which will make space for the new cells and allow them to take hold properly. These drugs will also deplete your immune system to prevent your body from rejecting your new stem cells. There are a variety of different regimes for conditioning, and your transplant team will discuss these in detail with you, including the side effects. The conditioning therapy and the transplant itself are likely to cause some side effects, so it is important that you are well enough to cope with these. Your medical team will request a number of tests on your heart, lungs, liver and kidneys to help this assessment prior to the conditioning therapy. To make administering medication as straightforward as possible, you will be fitted with a central line shortly before conditioning therapy begins. This is where a thin plastic tube is inserted into a large vein in your neck or upper part of your chest (called a ‘Hickman’ line) or in your elbow (called a ‘PICC’ line). This enables your medical team to administer medication, take blood samples and deliver the stem cells themselves. On the day of your transplant The stem cell transplant normally happens the day after conditioning therapy ends. First, your pulse, blood pressure and temperature will be checked. Then, the cells are passed as a transfusion through your central line in the same way as a blood transfusion. This may take up to a few hours, but is often completed in less than an hour. The transplant is not a painful experience and you will remain awake throughout. It can feel similar to having a blood transfusion. When the infusion has finished, your central line will be flushed through with saline (a salty liquid solution) to keep it clean. Your blood pressure, pulse and temperature will be checked again. The stem cell infusion is now complete and you will continue to be monitored until the new cells have started to grow and produce new blood cells. After the transplant After the transplant, you will need to spend some time in hospital to recover. This is typically around six to eight weeks, but this may vary. What happens to my blood after the transplant? In a successful transplant, your new stem cells travel to your bone marrow through your bloodstream. They attach themselves to your bone marrow and start to produce new blood cells. This is called ‘engraftment’, and typically takes around two to three weeks. Your blood will be regularly tested, and the first sign of successful engraftment is often an increase in your white blood cell or neutrophil count. After you have had your conditioning therapy and before engraftment, you will need blood and platelet transfusions a few times a week; this is to help top up red blood cells or platelets. This is a normal part of the process and does not mean that the transplant is not working, as it takes time for the new cells to start being produced. Once you have neutrophils increasing in your full blood count, the doctor will send a test to the laboratory called an engraftment test. This test will tell the doctor if these neutrophils are from the donor. If they are mostly from the donor, it means that the transplant has worked. Your stay in hospital You will need to take a number of medications for the following reasons: to help control your new immune system to protect you from bacterial, fungaland viral infections to control symptoms and side effects You will be placed in protective isolation on the day of your stem cell transplant (and possibly before it). This means you will be in a germ-free environment away from other patients, to protect you from picking up infections while your blood cell counts are low. Your transplant team will monitor you very closely to make sure all your physical and blood tests are normal, and to make sure they can treat any potential problems early. Most hospitals will allow you to select some people who can enter your room, and you can stay in touch via social media and phone calls. Sadly, most isolation wards don’t allow children into the patients’ rooms. Isolation can feel strange, but maintaining a routine where possible can really help. This may be something as simple as showering each day, or leaving your bed for mealtimes. Entertainment (books, music, podcasts, films, gaming, etc.) will help the time to pass more quickly. Even a small amount of physical activity can help to reduce fatigue and maintain physical strength. A physiotherapist should be able to give you specific advice about exercises that you can undertake safely. Side effects During the first weeks of your recovery, you are likely to experience some side effects, and some of these may carry on for longer. Most of these early side effects come from the chemotherapy that you have received during conditioning treatment, and may include nausea and vomiting (sickness), diarrhoea, a sore mouth, a loss of appetite, weight loss, hair loss, fatigue and an increased risk of infections. These are all common side effects and can usually be treated effectively, so it is important to alert your medical team if you experience any of these. Graft versus host disease (GVHD) Your stem cell donor will usually be very well matched for you but not identical. Therefore, there can be some immune response from the new donor cells to your own cells. This is called graft versus host disease (GVHD). It normally presents with an itchy skin rash or with vomiting and/or diarrhoea, but can also affect other parts of your body. Your transplant team will be monitoring you closely for any signs of GVHD. To reduce the chance of this complication, you will be given medication such as ciclosporin or tacrolimus to preventthis. You will most likely need to take this medication for nine months to a year after your transplant. Fatigue Fatigue is a common side effect. As strange as this may sound, gentle exercise can reduce treatment-related fatigue. Fatigue can feel overwhelming, but being aware that your energy levels are likely to fluctuate can help to keep things in perspective. Fatigue can be managed by: maintaining your energy levels andplanning ahead physical activity and exercise sleeping well and regularly Read more about how to deal with fatigue Returning home When the time comes to return home, you may feel relieved, but also concerned about coping without the constant support that you received in hospital. You can reassure yourself with the thought that your doctors and medical team will only recommend you returning home when they feel that you are ready to do so. Returning home is a big step in your recovery, but it can feel strange and isolating, especially if you spend large parts of the day at home alone, or if you live alone. Breaking the day down into achievable goals can help the day to pass more smoothly: for example, taking a short walk or preparing a favourite meal. Mental health To assist with your mental health, there are various techniques you can try, including deep breathing, meditation techniques and mindfulness. There may come a time when you need extra support to help you to cope. We would recommend that you talk to a medical professional if: you’ve been feeling low for more than two weeks you find yourself unable to perform even important tasks because of a lack of motivation you feel significantly more anxious than usual Find out how we can help support your mental health Immunosuppressive medications To reduce the risk of GVHD and also to make sure that your transplant is successful, it is likely that you will need to continue some immunosuppressive medications for approximately a year after your transplant. These help stop your immune system from rejecting your new stem cells. After this time, your medication will be gradually reduced and then stopped. Ongoing issues Having a stem cell transplant can have a large impact on your life moving forward. In some cases, there can be a large impact of a stem cell transplant on your later life, but other people have no issues at all. It is important to remember that the primary reason for your transplant is the improvement in your overall health. A stem cell transplant may sometimes lead to issues with fertility and also early menopause, but this is unlikely as the combination of chemotherapy you will receive is usually quite gentle. Stem cell transplant recipients can have a slightly higher risk of developing a secondary cancer later in life. If this happens, these are all due to the chemotherapy that you will have received. As with all cancers, early diagnosis is key, so it is important not to delay in seeking advice if symptoms occur. Many side effects will improve quickly, but some may develop later or persist for longer. These may be caused by changes in medication, how well your new immune system is developing, or GVHD.You will be monitored over a long period of time to make sure you have not developed any long-term effects from your treatment. These include: weight loss pain diabetes issues with joints and muscles kidney or liver problems cataracts loss of libido memory loss and concentration issues This list may seem overwhelming, but it is extremely unlikely that you will develop all of these issues, and in some cases you may not experience any. For this reason, you will be followed up for checks at least once a year during your life. Hospital visits Everybody’s recovery is different and some people may need to visit the hospital more often and for longer, but the frequency of these visits will decrease over time, from weekly to eventually annually. You may have some setbacks and pick up infections, meaning that you may need to spend some time back in hospital. This is a natural and expected part of your path to recovery. Your relationships Having a stem cell transplant can be a stressful time both for you and for those closest to you. You may find that your roles and responsibilities at home and at work change, as well as you needing to rely on others more heavily than usual. As much as possible, try to keep talking and communicating, and don’t make any life-altering decisions at this time. Having a stem cell transplant is an intense and often difficult experience, but the ultimate aim is that your life moving forward will be vastly improved. If you have any concerns or questions, your medical team should always be able to advise and assist you. The Aplastic Anaemia Trust Support Line is also available for anything you might want to talk about. Want to hear from other people who have had a stem cell transplant for aplastic anaemia? We hold monthly online chats for people who are pre- or post- transplant. Find upcoming dates on our events page. You can find blog articles and videos from people talking about their experiences of transplant here. Manage Cookie Preferences